Suggest Treatment For Fractured Ankles

Posted on Thu, 16 Mar 2017

Question: Hi Doctor,

I ha reached out to you before on my elbow fracture. Thanks for your guidance I have recovered well now.

Unfortunately my mother twisted her ankles and fractured the shaft bone under the little finger on her left foot. The doctor has plastered her and said she may need to be in the cast for upto 6weeks. Also prescribed pain killers and anti-inflammatory tablets for 5 days.

She is 55 years old. She has slightly higher sugar levels (around 105-110). And has no other history of any other diseases. She is pretty active in physically.

Can you please advice. If a surgery here can shorten the recovery time. If there are any other alternates to wearing the cast for 6 weeks. Also have read at a few places about orthopaedic boots. Will that be appropriate for her.

I have attached the x-ray.

Thanks for your help.

Answered by Dr. Mahaveer Patil (1 hour later)

Brief Answer:
Avoid surgery

Detailed Answer:
Hi Mr XXXX

Nice to hear back from you.
Its good to know that you have recovered well from your elbow injury.

I have seen the attached Xray. It is a minimally displaced shaft fracture of 5th metatarsal of the foot.

There are different modalities other than plaster cast by which this fracture can be treated, For e.g,- open reduction with plate and screws,K wire fixation, Cancellous screw fixation etc. But all these are surgeries,that carry anesthesia risks as well as risks of infection (considering her blood sugar).

Also,any of these surgeries will not reduce her immobilisation time.She has to be non-weight bearing with rest for 6 weeks even if she undergoes any of these surgeries.

Above all,after 1 year or so,she will need another surgery to remove back the implants.

Resultwise,there won't be much functional difference between a plaster cast treatment and a surgery.

Even with plaster cast,if the fracture unites well,she will be able to walk just like she used to walk before the fall.

In my personal opinion,continuing with plaster boot cast and avoiding surgery is the best option for her.

She can ambulate by using a walker / crutches keeping the affected leg off the ground ( she should avoid weight bearing on the affected leg).

Orthopaedic boots serve similar function as plaster casts,except that they can be removed whenever you want (which is not desirable).

Give her calcium,vitamin D and cissus qudrangularis tablets for better fracture union.

I hope the answer was useful.

Feel free to ask me any follow up queries that you may have.

Thank you.
Kind regards.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Mahaveer Patil (22 hours later)

Thanks Doctor for the detailed response. We will go with the cast and avoid surgery.She is starting to use a walker. But sometimes (very few) just presses on the heels of the injured foot while walking, as hoping with one leg with full body weight hurts that uninjured leg. Is it ok? or should the injured leg be completely off the ground while walking and only one leg be used.
She is taking calcium tablets. We don't know what her vitamin levels are. So which vitamin-d tablet will be safe to take without causing any overdose.

Should the orthopedic boots be worn after the cast is removed, or at a later stage.

Answered by Dr. Mahaveer Patil (1 hour later)

Brief Answer:
COMPLETE non-weight bearing

Detailed Answer:
The affected limb should be "COMPLETELY" off the ground. It should not even touch the ground.

Depending upon the status of the bony union after the cast is removed,a decision about wearing orthopaedic boots can be taken.

Cap. Uprise D3 (cholecalciferol 60,000 IU) or similar medicines - 1 capsule should be taken once a week for the next 4 weeks (4 tablets in total)

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Kampana