Broken fibula and ankle bone

by DS
(India)

Hi, I had an accident 10 months ago and broke my fibula and ankle, surgery was done, screw inserted in the ankle and plate in the fibula. Last X Ray showed broken ankle bone to be healed fully and fibula almost healed. Though the swelling has reduced considerably on the fibula side,but the muscles have concentrated on one area on side of the plate and not uniformly spread.They form a small ball like shape at the end of the day. Also on the skin on the top of muscles feel dry and is less sensitive compared to other less and also numb. Any insight into this?

RESPONSE

Hi DS,

I am looking at your x-rays and here is what I see and what I do not see. First of all, I see no sign of a screw or plate, so I assume you are showing me the pre-operative x-rays that were taken right after your accident.

It might have helped a bit more if I could have seen the post-operative x-rays since your complaints seem to be related to the after effects of the surgery.

The good news is that in your narrative, you make no mention of having any real pain and at the end of the day that is what you should be most concerned about.

Since surgery to correct bone trauma can only be planned out to a certain extent and since your surgeon has to work with what injuries you sustained there is usually a high incidence of mild side effects. This is almost impossible to avoid.

You have a plate in your lower leg. Depending on how large it is, how many screws are used to hold it in place, the angle it sits relative to the bone, there almost has to be some protrusion of the plate which in turn is going to press against the peroneal muscles and create non-symmetry in your leg. Other factors such as how muscular you are, how much fat you have around the area will also contribute to the problem you mentioned.

The short answer is that there is not much you can do about it, unless somewhere down the road you request the plate be removed. I would suggest to you that the fibula bone is a poorly vascularized bone and most surgeons would probably recommend the plate stay in place as its removal could weaken the healed fracture site and once again cause problems. I would also suggest that if the plate were removed further down the road the symmetry that you desire, might not occur anyway since the changes that have occurred from the plate would probably remain.

Again, most surgeons would tell you that since you ultimately have no pain, the surgery was a success and most would have no interest in removing the plate.

As far as the numbness goes, I am afraid you are probably stuck with that as well. Invariably the incision to reduce the fracture and insert the plate, cut some superficial sensory nerves leaving you with numbness. The dryness you mention may also be the result of the incision as superficial vasculature may have been altered as well.

Now, over time you may see some reduction of numbness since nerve tissue is one of the few tissues in the body that regenerate. It could take a year or two, or might not occur at all.

I do not know what your incision looks like, but one piece of advice I can give you is to keep that area of the leg that feels numb and dry, well hydrated. Apply dry skin lotion two or three times a day. Obviously, that should help with the dryness, but it may also reduce some of the sensation of numbness. You will then have to wait to see if any of your missing sensation returns.

Marc Mitnick DPM
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