AboutJoe A Shaw PA-C Expertise Most general questions that have to do with orthopedic and /or occupational medicine or ergonomics. With a focus on upper extremity disorders such as carpal tunnel syndrome. After many years of treating and diagnosing carpal tunnel syndrome I have developed a detailed website about carpal tunnel syndrome at Carpal-Tunnel-Symptoms.com
Experience I have been a board certified Physician Assistant for 17 years, in the fields of occupational and orthopedic medicine.
Organizations American Academy of Physician Assistants, State Academy of Physician Assistants.
Education/Credentials Physician Assistant degree from the University of Florida College of Medicine PA program. Bachelor of Health and Science degree. Board Certified Physician Assistant, Ergonomic certification, University of Michigan ergonomics certification. Associate Science degree in Emergency Medical Technology. Former Paramedic, EMT and Firefighter.
Awards and Honors Current certifications in Advanced Cardiac Life support, and Basic life support, and CPR certification. University of Michigan Ergonomic training and certification.
Tib/fib fracture 5+ months ago, required surgical repair w/ hardware, etc. everything progressed fairly typically, altho was not allowed to put any weight on the leg until > month 3, then <50%. At that point fibula was healed, and while there was significant progress w/ tibia, it hadn’t healed completely. Month 4 we went ahead with a bone stimulator. Month 5, graduated to a cane, but still have to wear the boot.
I’ve now had the stimulator for +/- 6 weeks and am about 6 months from fx - finally my question: my leg and ankle are still noticeably swollen. And, there is quite a bit a pain. While, I occasionally feel the pain at the fracture site (generally when I do not have the bone stimulator on and the swelling is somewhat less), a significant portion of the pain appears to be associated with the location of the screws - both fibula and tibia. I cannot decide if the pain is because I am now effectively walking on it, albeit w/ cane and boot, or because of swelling. And, while I understand the principle of the stimulator and drawing blood to the fx site so as to advance the healing of the bone (thus the swelling), the swelling seems very extreme to me.
thoughts? any input greatly appreciated, thanks in advance, gael
ps: should i mention the carpel tunnel problem caused by 5 months on walker/crutches :) ?
Answer Gael,
You had a bad break for sure and as you probably know by now these can heal very slowly and sometimes not very well. You have great alignment and hardware placement from the one view. The bone stimulator although can cause transient swelling is/was appropriate and used in resilient cases like yours. I don't know if bone grafting has been discussed but this may be an option IF you don't continue to improve?
I think it will be about 6 more mos before this gets where you can get around fairly well.
Eat a well balanced diet, keep wt appropriate, stop smoking if you smoke and keep wt bearing as tolerated..then elevate the leg.
Yes CTS with crutches for 5 months..hopefully it can resolve as you use the crutches less. It is recommended to use night splints to keep the wrist in a neutral position while sleeping.
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