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Broken ankle in 2 places

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    Broken ankle in 2 places

    Hi all,

    39yo female, t-9 complete, 17yrs post here. Just broke my ankle last week. I'm not %100 sure when it happened, but I'm pretty sure it happened at the adaptive PE class I just started. The instructor put me into an elliptical-type standing frame, and I think it happened when transferring out of it because the ER doc said that this is a twisting type of injury (bimalleolar fracture). I used the frame Monday, then Tuesday afternoon I noticed my left foot looked swollen, was flushed and feverish to the touch. Went to the ER for an x-ray and got a soft cast put on until the swelling goes down, after that comes surgery.

    I have a lot of questions for the orthopedic surgeon. Is surgery absolutely necessary if I want to stand ever again? What is recovery going to look like? What about skin breakdown beneath the cast post-surgery? I also want to know if the doc who put me on Fosomax and calcium a few months ago due to my osteoporosis did the right thing, since studies seem to show otherwise for SCI? Should I continue to try to stand, or is it too late for me bone-wise?

    I'm not very old, but my injury is. It's taken a week but it's really settling in now, how much my body has changed over the years of being paralyzed. I'm trying to not let depression overtake me. This is my first fracture post-SCI.

    Can anyone think of any other questions I should be asking?

    I'm curious about the equipment that caused or allowed the twisting break to your ankle. Was there a stirrup? Velcro? And, yes, we don't always know for sure what caused us an injury. We have to 'think back' over the past day or two and try to figure it out. People who aren't sci can easily think, "How could you not notice THAT?"
    Female, T9 incomplete


      I would ask about hardware - are they planning to place screws, etc and if so, will they remove them or do they plan to leave them in place?

      Can you develop dysreflexia?do they have a plan for that in the or and during recovery?


        Ask if your Orthopedist has sub-specialty training in foot/ankle surgery. They'll be more familiar with this kind of fracture in osteoporotic geriatric patients who have fallen, but the treatment options are similar. Scroll down to the section on bi-malleolar fractures.

        Your cast or molded brace will likely be bivalve to allow for removal, skin cleaning and adjustment for swelling.

        You'll be in and out of the acute care hospital in a few days. Do you have help at home for transfers and ADL's? Would you qualify for a short stay at an inpatient rehabilitation unit?


          Originally posted by Vintage View Post
          I'm curious about the equipment that caused or allowed the twisting break to your ankle. Was there a stirrup? Velcro? And, yes, we don't always know for sure what caused us an injury. We have to 'think back' over the past day or two and try to figure it out. People who aren't sci can easily think, "How could you not notice THAT?"
          No velcro or stirrup, but the footplate does have a large lip, almost like a cup for your foot. So I think it happened when we were trying to get my foot out during a transfer.

          A funny thing: someone opened a door for me yesterday and said, "Come on in here with your hurt foot!" I realized that she probably thought that that was why I was in a chair. It was odd.


            Did you have to give the exercise program a recent bone density test result before they let you enroll?


              If you don't plan on ambulating and the fractures are not displaced and you may not need surgery, as I was told at the my ankle fracture, which involve the fibula and medial malleolus. I used a removable stirrup type brace which I removed when relaxing in bed with my leg elevated and ankle iced, and kept it on all other times. What is normally 2 to 3 month healing process in an able-bodied person turned into a 6 to 8 month process just to get it to the point where I was out of the woods. The osteoporosis and the lack of ability to partially weight bear, which causes a bone strengthening stimulus, led to a fracture that, even after a year, the line was still faintly visible.

              I was pretty scared when the ER for my leg in a tightly ace wrapped molded boot until I saw the orthopedist. I can only imagine how my skin was going to look after just 24 hours, given how short it takes for tissue damage to occur. I was never going to need a functional ankle joint. But once you going into surgery for internal fixation you're opening yourself up to a host of potential problems.

              I was lucky in that I got an overhead lift because of a permanent hand injury which precluded transferring anymore before I got my ankle injury. The lift proved essential in making sure I didn't risk damaging it again during the initial critical healing stages.

              You will definitely need more help to ensure that you do not apply any damaging forces to the ankle joint. This includes turning assistance at night when before you might have been applying some torque to the ankle and not have known it. Granted, internal fixation will prevent displacement, but the trade-off is one that needs to be weighed carefully.


                The surgeon wants to make sure that the work they perform is successful so make sure you have a list of all your questions at your appointment.

                All non-weight bearing people with SCI are at risk of a fracture
                Take the process one step at a time

                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


                  I have broken mine 3 times. I could see how you do it transferring on a frame. Out shoes sometimes stick on the footplate. I broke my leg transferring to the floor. I didn't real8ze the amount of pressure when you have your legs crossed and sit on them. I have only had soft casts or a boot. They're really cognizant of sores. A cast you can't take off isn't usually a good idea with paralysis.


                    make sure they do not put a hard cast on you and if they do make sure you have weekly cast changes to monitor your skin.
                    T6 Incomplete due to a Spinal cord infarction July 2009


                      Yes, laurielou, I get that a lot, too. When the car hit me and broke my back, it also took off my left leg above the knee. So, in the nursing homes, many (and possibly all) thought that I was in a wheelchair due to my leg amputation. Everyone would say something like, "But you'll be getting a prosthetic soon?" Even the man who had hit me with his car asked this, and then his face fell when I told him I'm paralyzed.
                      Female, T9 incomplete


                        I'm a T-11 para. Over the last few years, my calcium levels have gone down sharply along with a low bone density study. I am now on a sub q injection daily of Forteo. It is hopefully building up and strengthening my bones. I know that there was fear of me breaking a bone when my bone density was low.
                        I refuse to tip toe through life, only to arrive safely at death.



                          Originally posted by 2drwhofans View Post
                          Did you have to give the exercise program a recent bone density test result before they let you enroll?
                          No, they did not.

                          Thanks for all your replies! Here's an update for anyone else who may search for this topic in the future:

                          Three days after the doc put the solid cast on I went back and demanded a removable cast (after spending those 3 days with horrible anxiety, imagining an uncontrollable pressure sore forming). He wasn't happy with the request, saying "But, your bones!" And I was like "Yeah, but my skin!" We went back and forth like that a couple times before he relented. They simply cut the hard cast down each side and then wrapped it back up with an Ace bandage. This way I could take it off as often as I wished. I started with checking it each day, eventually moving to every 3 days once I could see that the cast wasn't pressing too badly anywhere.

                          It's been a little over 3 months since the break. I have a monthly check and x-ray next week. Last check up he said that slowly but surely it was healing. My mom was expecting it to be healed in 6-8 weeks like a normal person; she often ignores the realities of what being paralyzed for 17 years does to one's body. She still doesn't believe that a simple transfer could break my ankle in 2 places.

                          TMI tangent: I took off SO MUCH dead skin from my foot the other day -- very gently, of course. I didn't want to move the ankle too much, but I also know that too much dead skin build up can cause issues in itself.

                          My foot below the break is still very swollen each time I check it. I try a very, very gentle massage with oil to get the circulation going, and try to raise the foot at the end of the day. The oil helps the skin not get pulled, which helps move the ankle as little as possible. The oil also helps dry "cast-skin".


                            Hi there,
                            I'm curious do u remember what kind of surgery u had & how did it go 4 u? I had broken ankle that didnt heal correctly & now facing surgery, so I'm curious what type of procedure u had & ur outcome


                              This is why you go to a doc that does spinal cord injury. When I broke my femur they put the rod in also. I had a brace I had to put on for like 3 weeks. He said after if I was lazy he won't have put the brace on. I actually used it another month as I got so used to it. I just didn't want to go threw it again
                              Good Luck whatever they do.