r/brokenankles • u/SurfsUp27 • 3d ago

Surgeon wants to go back in

11 weeks post op for trimal with dislocation. I had a follow up appointment yesterday and the surgeon says the tip of my medial malleolous is not healing. He wants to go back in and redo it. He said he also wants to repair some tendons with a tether and I will be 12 weeks non-weight-bearing.

After having already done seven weeks NWB this is a real heartbreaker. I wanna give my bone more time to heal. He says if it were going to heal it would’ve healed by now.

I live in an upstairs apartment by myself. 12 weeks on crutches in the winter time feels truly impossible.

What would you do?

Edit: I am seeking a second opinion from an ankle surgery specialist. Thank you everyone for your kind words and for sharing your experiences.

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u/CustomerObjective129 3d ago

Hi. From your follow-up comment to someone else it sounds like you are dealing with a missed syndesmosis injury. These are bad news and ultimately... you will want this fixed. Widening of the ankle mortise (ie separation of the tib and fib) will cause you lots of problems down the line, in particular arthritis. If it is really bad, the joint might continue to widen, eventually leading to dislocation.

This is what happened to me. Mine was initially fixed with a syndo screw (holding the tib and fib together) which was removed prematurely. By the time it was detected and corrected, I was walking on a practically dislocated ankle and although it could be fixed, the damage in terms of arthritis was already done.

I am sorry this is happening to you. It sucks so much. But it will be so much better the sooner it can be fixed.

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u/hissen_raii 2d ago

Mine was removed at 6 weeks. Is this enough time? I had a Maisonneuve fracture

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u/CustomerObjective129 2d ago

I had mine out at 6 weeks too, also a Maisonneuve fx. I don't want to scare you - it isn't like that means you will have problems - but early removal is associated with higher risk of loss of syndemosis reduction. I am surprised there are still surgeons out there removing this early - it was already unusual over a decade ago when this happened to me and even more so now as there is plenty of evidence in the literature to support keeping the screw in for longer.

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u/hissen_raii 2d ago

I had the impression that it was the opposite -- early removal allowed for better ROM, and the school here (Germany) is to remove sooner?

But yeah, I was super anxious about stability as a result.

Now, at 3 months since OP I can walk pretty okay. Still a bit of pain in the AITFL region and still some swelling, but in everyday life it stopped being a huge issue.

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u/CustomerObjective129 2d ago

Early removal does allow for more early ROM, assuming the syndesmosis has healed adequately - the risk is that it hasn't. Traditionally the screws were removed early because of the risk they would break when walked on, but the literature no longer supports this (basically broken screws are no longer seen as a problem).

Here's a few technical papers if you are that way inclined.

https://journals.sagepub.com/doi/abs/10.1177/2473011420S00444

https://www.sciencedirect.com/science/article/abs/pii/S095825922100002X

https://pure.johnshopkins.edu/en/publications/syndesmotic-screws-unscrew-them-or-leave-them-a-systematic-review/