Question: 9 weeks or so status post injury, having sustained a medial malleolar fracture of my left ankle on February 17, 2018 (2 x-rays attached). I had progressed routinely through short leg cast, then non weight bearing boot, then finally weight bearing boot by April 6, with no restrictions (2 x-rays from that date attached). Within a week, I was full weight bearing with only one crutch. Shortly thereafter, I was able to full weight bear without the crutch. By this time, there was no pain on the fracture site; only swelling and soft tissue stiffness and pain. I've been sleeping without the boot, and am able to dorsiflex and plantar flex to a much greater degree than a few weeks ago.

On April 23, I slipped down some stairs and landed hard on my injured ankle. A day later, I began to feel pain at the site of the fracture again, in the malleolar area. I went to urgent care for imaging of the fracture. The x-rays showed, what the doctor believed to be, a refracture at the top of the original fracture line. (4 x-rays attached: 2 full, 2 zoomed). It looks like there is a slight jagged edge near the top, but that the bottom majority of the fracture has healed. This jagged edge was visible on an earlier x-ray, about a month ago. The urgent care doctor noted that it could be a matter of the view angle, but believed refracture was a possibility. She advised that I consider non weight bearing again until I have my orthopedic follow-up to be safe. However, this is not feasible with my current work. She also indicated that it was possible my ortho would review it and determine weight bearing was perfectly fine.

I can comfortably walk with no pain using a single crutch, and can still comfortably walk with no crutch at all, except in certain positions, where I feel slight pains at the injury site. Notably, I am scheduled for orthopedic follow up on the 30th, and WAS originally planned to receive a prescription for physiotherapy on that date. I will, of course, follow-up with my ortho.

1) What are you thoughts on this based on the x-rays and the pain-free mobility I have achieved?
2) With the majority of the fracture apparently healed, is further exacerbation or enlarging of the fracture likely, assuming no further trauma to the site? In other words, if I carefully resume (partial) weight bearing, that is, with one crutch as a cane, and this is comfortable for me, is it likely that the bone is sufficiently strong that this "crack" at the top of the original fracture line will expand?

Please note that x-ray images may be in a supplemental post. I believe I am limited to three in the original question.

Thank you again Dr. Tayal.

I have two follow up points to ensure I fully understand. Although it was pain free-motion before this most recent trauma, there IS some pain and slight tenderness to palpation in the malleolar area with certain positions. Does this change your assessment? It is generally pain free to walk and bear weight with the single crutch, and I am comfortable doing so.

Second, are you saying that because there is sufficient union of the original fracture, it is not likely that this re-fracture (visible at the top of the most recent x-ray) will continue and "spread" if I continue with my current careful weight bearing and single crutch? If I continue this way, assuming no further trauma, the refracture will continue to heal?

Thank you again.