Operation versus conservative management broken ankle

[Lushmetender]

Hi broke my ankle last Monday and went to A & E on Wednesday. Right fibula broken and told unstable so needed an op. Day of op came and said they couldn’t fit me in so 3 options. Wait another day and have it the next day. Second I could be referred to the hospital local to me. Third I can treat with conservative management but keep a close eye in case it misaligns as they had managed to straighten in a better position when putting a cast on. I opted for 3 and my FIL and BIL both being drs said I’d made the right decision to get a second opinion. I’m a big fan of not meddling until you need to but I’m v anxious. I have an appointment next Wednesday to check the alignment but wondered if anyone had this dilemma before and what was outcome? If conservative management did you go to have surgery and if had surgery had you wished you’d tAken the conservative approach? They told me they would normally leave the type of injury I have but I had bad ligament damage on the inside hence why they immediately said I needed surgery. When I spoke to the consultant he said that he is in the business of ‘fixing’ things and therefore often don’t give time for informed choices of patients. I can’t work out if he wanted my bed or if it is genuinely possible it could heal without surgery. Any experience?

I'm just recovering from surgery for a bad ankle fracture. I didn't have an option but from what I've been reading surgery can be the better option because there is a possibility your fracture won't heal properly and you will have problems in the future and may require surgery anyway. I think I would want to avoid that possibility.

Are you worried about surgery?

I’ve broken both my ankles. One required surgery, the other just a cast and crutches. I might be wrong about this but perhaps your age makes a difference? Also, is it realistic for you to rest the ankle and not reinjure it?

Hi yes I’m worried about surgery and the pain plus the risks associated. I’m 50. I have an appt on Wednesday so need to see if the ankle has come out of alignment at all. I am resting just now and have 3 children and husband and so are helping. Both ankles - eek how are you coping? What happened to both and how was the surgery!

I wouldn't...go for surgery. If the conservative management goes wrong...it's a whole lot more difficult. An athlete wouldn't consider it so I wouldn't

Hi Lush i'm 46 I recovered from the surgery itself really quickly but obviously recovering from the injury is slow going whether you have the surgery or not.

I think I would be asking on Wednesday whether the overall recover would be quicker with surgery or without.

I had a silly slip on pavement in the rain and ended up with 2 breaks to ankle, broken heel and shin bone along with torn ligaments for good measure! My fracture meant my foot was pointing the wrong way and I was lucky the skin wasn't broken.

I'm so frustrated because I'm normally super active walking around 2 hours a day with the dog!

Really sorry to hear that! Bad with one broken bone never mind a few! How do you cope - are you able to move at all? I’m on crutches but just managing to go to loo and back at the minute. Had promised myself I’d go downstairs today but will leave it will tomorrow. Unfortunately I’m a scientist and I worry about both causing issues / darned if do or don’t!

I haven't been able to get upstairs in 5 weeks, we have awkward stairs. I bought a hands free crutch - peglegs.co.uk/iwalk3-vs-iwalk2/ which has helped downstairs. I managed to walk down the road to a friend's for coffee.

I'm now in a boot and am regaining movement but I am not able to weight bear properly still. I have another scan in 2 a week and a half to check all is good.

I would worry more about the long term recovery without the surgery. Walking on an unaligned ankle for life will be far worse than surgery. I know there are risks to it but I'd say they are far less likely than the risks of not having surgery.

I will see what they say. I have friends who are nurses who talked about orthopaedic surgeons and how they operate and bugger the consequences. I’d prefer to give it a chance as the only thing that said I’d need surgery was the ligament damage on the inside and they said they’d usually leave it to heal normally if it weren’t for that! Obviously if new X-ray shows it’s not going well I will have no choice but at least I’ll have got my head around it a bit more! This will help me a bit more psychologically but I do feel pretty shite after the covid year we’d all had only to have an accident on day 1 of holidays. Were you offered any psyche help?

No, and same as you my accident was on my first outing after lockdown and I was supposed to be going on a long awaited walking holiday 2 days later.

I'm just hoping to be more mobile by end of August / start of September now.

It is depressing to have another period of being stuck indoors but not a lot can be done about it unfortunately.

I thought "conservative management but check in case" was the norm me & DC have had experience of breaking something, initial x-ray, wait a week, 2nd x-ray to make sure bones still aligned fine and that was all (no further intervention).

Thanks liljkk- hoping I can avoid the surgery! The outcomes on both reading articles are inconclusive! Function seems slightly better but pain isn’t! I was hoping they weren’t doing it to get the hospital bed back but the nurse assured me that he wouldn’t say it if the consultant didn’t think it was an option! Gah! It doesn’t sound the worst fracture but important I make the right decision!

In fact what I don’t understand is why I’m not in more pain! I mean I cannot stand on it obviously but in the hospital I was fine on paracetamol and only took the oromorph in the hope I would sleep! But I didn’t! So glad I am home at least!

soft tissue injuries seem to hurt more than broken bones (anecdotally)
Friend with merely snapped ligaments was in huge discomfort.

I've broken my arm 3 times, a rib once or twice, birthed 4 babies -- from what I can tell, my husband's often dislocated shoulder trounced any of those. He had surgery 2 yrs ago to make sure it shouldn't happen again.

@lljkk

I thought "conservative management but check in case" was the norm me & DC have had experience of breaking something, initial x-ray, wait a week, 2nd x-ray to make sure bones still aligned fine and that was all (no further intervention).

I think it is, it is complicated breaks that require intervention.

They tried to reset my ankle but I was warned at the time that it was unlikely they could do it and to expect that I would need emergency surgery. I had to go straight from plastering for a second scan when they confirmed that surgery was required and I was immediately admitted to the trauma unit for the surgery.

It was agony though. I needed morphine. I was told that the fracture was about 'as bad as they get' and I was lucky the bones had not come out of my skin.

Where the OP situation is strange is there appears to be a dispute as to whether the surgery is required or not.

Hi the guy I first saw reset the ankle and I was wheeled up to ward anyway. It was the day of the op after fasting and when the consultant came said I had the options as they could. It fit me in that day. The consultant said the 2nd X-ray looked better. He said we need to keep an eye on it to check it doesn’t drift. If it does they’ll no doubt say I need the op. I hope not though as covid on the rise here along the way with the other possible complications. Sounded like it was best to delay surgery as I’d left it 2 days and if you have swelling it can causes post surgery blisters and can increase chance of infection. Wish I’d asked what type of fracture it was. Know that it was tibia (broken a bit off) but it was the ligament damage inside making it unstable

Thankfully I can conservatively manage the break! Weber b break and in one place. I’m fairly good position but they recast with a lighter more shaped form cast and go back in 4 weeks. Said I can even start using the stooky as a balance and to start putting weight on it. I’ll
Leave that a little while however!