Fracture dislocation of an ankle

A

airheadpenguin

Pre-takeoff checklist
Joined
Nov 4, 2012
Messages
495
Location
New Hampshire
Display Name
Display name:
airheadpenguin
I fell on some ice today and went to the ER with what was diagnosed as a fracture dislocation of the left ankle

Is this just a status letter at my next medical to get recertified type thing?

Sent from my SCH-I545 using Tapatalk
 
Many years ago, I screwed myself up much worse than that. It was more a self ground until you feel up to flying again (in your case, when you can work the rudder pedals) and are off the pain meds type of deal. No report to the FAA was required, but you will need to note it on your next medical.
 
AFAIK, unless it changes your physical abilities permanently (strength, range of motion, etc), a healed fracture doesn't require a status letter, just reporting on the next medical as part of the "visits to health professionals" list. But if you want to be sure, you can contact Bruce Chien via http://www.aeromedicaldoc.com.
 
I should have gotten pictures, it was quite the sight with my foot backward on the end of my leg

The preliminary estimate from the ER is 6 -12 weeks in the cast, I'll know more after meeting with three orthopedist on Monday

The good news is I have a clean ekg, I'm not diabetic, and I don't have high bloodpressure if only they had an ame handy

Sent from my Nexus 10 using Tapatalk
 
Last edited:
I hope you heal quickly...... and get back to flying soon.

(Sarcasm on) the way things are going in Oklahoma City, if you are not a perfectly healthy 21 year old with no childhood history of disease, you will get deferred (sarcasm off)
 
I hope you're following up with an orthopaedic surgeon and not going solely by the er doc's recommendations. Almost always this injury is treated with surgery, not just casting. Good luck regardless.
 
AcroBoy said:
I hope you're following up with an orthopaedic surgeon and not going solely by the er doc's recommendations. Almost always this injury is treated with surgery, not just casting. Good luck regardless.
Click to expand...

I certainly am. The ER x-rays showed that I avoided the tib/fib fracture both in the initial break and in the reduction

I'll be getting my sports medicine guy in on this to sound I do want to go back to running

Sent from my Nexus 10 using Tapatalk
 
My guess is that when you can walk unassisted without pain you should be ready to resume flying activities. The FAA may have a different take on this issue.
 
So here's the story, I fractured the tibia and the ER reduction on the ankle needs to be redone. So off to surgery later this week for some screws and pins.
 

Attachments

  • 0010067628_CR_6025.665113.1_20140224_001.jpg
    0010067628_CR_6025.665113.1_20140224_001.jpg
    618.3 KB · Views: 236
  • 0010067628_CR_6025.665113.1_20140224_002.jpg
    0010067628_CR_6025.665113.1_20140224_002.jpg
    775.7 KB · Views: 222
My amateur understanding is on you final visit with your doctor have him sign note (work release?) Stating that you have "No Restrictions" take this note with you to your AME when you do your next Medical.

Brian
 
You fractured your fibula not the tibia, and this typically would be fixed with a plate and screws. It also looks like your ankle mortise is widened on the medial side (inside). (the space between your tibia and the talus)

You very well may have flipped a piece of your deltoid ligament into the joint. This would require two incisions, one for the plate and screws, and another on the inside of your ankle. You did not include the important lateral x-ray- I hope they got one as well.

As I said in the earlier post, it is pretty rare to dislocate an ankle and not get an associated fracture. Your x-rays confirm this.

Your fracture is very obvious- the ER doc you saw was a moron if he or she missed this- really, really weak. What would they be doing if you had a serious life threatening event? I wouldn't be going back there anytime soon.

Personally, I would get a copy of the note from the ED doc where it says he/she did not see a fracture, then get copies of the notes and x-ray reports which clearly do show an obvious fracture, and send it all to the risk management people at the hospital where you were initially seen.

This serves the purpose of hopefully having the hospital educate the ER doc that missed your fracture, and perhaps will help someone else in the future with a similar injury. No one knows everything, but missing this fracture, if it's as you reported, is egregiously bad.

You're probably looking at the surgery itself (keep it elevated so it doesn't swell too much and your skin is OK with no blisters), perhaps 4 weeks non-weight bearing in a splint/cast, then PT with range of motion, balance, strengthening, etc in a boot for a while. This is all somewhat surgeon dependent.

How do I know this? It's the internet, and I'm a full time academic orthopaedic orthopaedic surgeon. Good luck.
 
Not that it's that important, but this is a pronation/external rotation injury. You can search on the Lauge Hansen classification. It looks like your syndesmosis is widened as well. not uncommon with these injuries. This would probably require a screw across the tibia and fibula, which would be removed at some point. The other hardware would stay in place unless it bothered.

The medial side does look widened, and you can see a fleck of bone where you probably tore your deltoid ligament.

Sorry for the jargon- you can ask your orthopaedist or look it up if you want.

Again, good luck.
 
Jim you're completely right, Thursday was surgery to install the hardware in my ankle for the fracture and to fix the spacing around my foot. I'm currently sitting with my ankle up in a splint, next week supposedly onto a boot but no weight bearing activity for 4 weeks and then we'll see.

Post op x-rays to come next week
 

Attachments

  • 0010067628_CR_6025.665113.1_20140224_003.jpg
    0010067628_CR_6025.665113.1_20140224_003.jpg
    943.6 KB · Views: 205
Last edited:
Yes the mortise looked quite ugly! That is what I meant by this can be a nasty injury.

Just curious, why did ER do reduction? Was there vascular compromise (foot cold and pale) or was Ortho available not available. Personally I wouldn't have done anything but take your pain away until Ortho could address this knowing how significant an injury it can be.

Glad to hear you have been taken care of and on the road to recovery!
 
Last edited:
Usually it's not too hard or painful to reduce a dislocated ankle, and can help the blood supply to your foot. Sounds like you're on the right course.

Recognizing an obvious fracture is pretty basic- an er doc should have recognized this one easily. Working in a tertiary care facility it ****es me off when lazy or ignorant docs try to dump patients on us rather than making an effort to do the right thing for the patient.

Anyway, again, good luck.
 
AcroBoy said:
Recognizing an obvious fracture is pretty basic- an er doc should have recognized this one easily. Working in a tertiary care facility it ****es me off when lazy or ignorant docs try to dump patients on us rather than making an effort to do the right thing for the patient.
Click to expand...

Having scanned the entire thread again, I fail to see where at any point the OP claimed the emergency physician didn't recognize the fracture. In fact, in his first post, he referred to a diagnosis of a fracture-dislocation of his ankle. This fracture would have been identified by a first-year medical student. It is not conceivable that any practicing emergency clinician would miss it, so I'm not clear on what precipitated the anti-EM rants.
 
Because post 9 by the op states he was told he "avoided a tib-fib fracture".

Because even with an obviously widened mortise he was told that he could be treated closed in a cast.

Unless the OP made it up, he was given bad information by the ED doc.
 
Or, if the er doc was suggesting that a fracture dislocation of an ankle joint is less significant than a tib-fib fracture, this is not necessarily correct. Most people with a closed tibial nailing are going to have less long term sequelae than an ankle dislocation.

Or, that with a widened mortise and a comminuted fibula fracture this injury could be treated closed in a cast- this information was also incorrect.

None of us who practice knows everything- my point is that if we don't know the answer then tell that to the patient and defer to the specialist rather than making stuff up that could be misleading.
 
BrianR said:
Having scanned the entire thread again, I fail to see where at any point the OP claimed the emergency physician didn't recognize the fracture. In fact, in his first post, he referred to a diagnosis of a fracture-dislocation of his ankle. This fracture would have been identified by a first-year medical student. It is not conceivable that any practicing emergency clinician would miss it, so I'm not clear on what precipitated the anti-EM rants.
Click to expand...

Gotta love the Monday morning QB'ing. How about this scenario: OP had everything done right. In fact, not only did the ER doc Dx the fracture (an 8th grader would) but he was planning on sending the OP for surgery (hence the EKG and blood work) but couldn't get the orthopedist to come out and was told to just reduce it, splint it, and send him to the office. Of course, the ER doc probably wouldn't tell the OP that, nor would he advise him to file a complaint.
Way too many if's here.

Glad you're ok
 
AcroBoy said:
Or, if the er doc was suggesting that a fracture dislocation of an ankle joint is less significant than a tib-fib fracture, this is not necessarily correct. Most people with a closed tibial nailing are going to have less long term sequelae than an ankle dislocation.

Or, that with a widened mortise and a comminuted fibula fracture this injury could be treated closed in a cast- this information was also incorrect.

None of us who practice knows everything- my point is that if we don't know the answer then tell that to the patient and defer to the specialist rather than making stuff up that could be misleading.
Click to expand...

No disagreement there. I took post #9 to mean that the OP meant he had no tibial fracture, not that he was told he didn't have any fracture. I assumed from the mention of lab work and EKG that the need for surgery was recognized.

brentee said:
Gotta love the Monday morning QB'ing. How about this scenario: OP had everything done right. In fact, not only did the ER doc Dx the fracture (an 8th grader would) but he was planning on sending the OP for surgery (hence the EKG and blood work) but couldn't get the orthopedist to come out and was told to just reduce it, splint it, and send him to the office. Of course, the ER doc probably wouldn't tell the OP that, nor would he advise him to file a complaint.
Way too many if's here.
Click to expand...

Now that scenario is entirely plausible...much more believable than the emergency physician "missing" the fracture. I think I'd develop chest pain if my orthopedic surgeons got out of bed in the middle of the night! :)
 
If I had to mail the FAA every time I slipped on the ice and fell this winter the US would be out of stamps. My left elbow sill doesn't work quite right.
 
brentee said:
Gotta love the Monday morning QB'ing. How about this scenario: OP had everything done right. In fact, not only did the ER doc Dx the fracture (an 8th grader would) but he was planning on sending the OP for surgery (hence the EKG and blood work) but couldn't get the orthopedist to come out and was told to just reduce it, splint it, and send him to the office. Of course, the ER doc probably wouldn't tell the OP that, nor would he advise him to file a complaint.
Way too many if's here.

Glad you're ok
Click to expand...

Actually the op never said the er doc got labs or an EKG. He said his EKG was clean. There was no mention of labs.

Unless the skin and or blood supply were at risk this is not an emergency. Surgery could be done in the AM or in a few days when the swelling decreased. It certainly sounds like the subsequent treatment was correct.

Working at a level I trauma center I agree it is frustrating to get calls from outside ER docs about problems that could easily be treated at the local hospital but the orthopedist can't or won't even come in to see the patient, let alone do some initial treatment or stabilization.
 
OP again, following surgery and staying off of it for a few weeks my orthopedist cleared me to get back to walking in one of those orthopedic boots which I'm sure means I'm still medically deficient.

The question I had is, as I understand it the issue with with range of motion and being able to not use the boot for support. So how normal does the ROM have to be, keep in mind I'm in my 30s and have roughly the ROM of 0 degrees (perpendicular to the leg) to about 30 degrees (foot pointed down)
 
When you are out of the boot, close to done with PT, and can walk without pain.

Can you climb into a plane, work the rudder pedals and brakes, and egress if necessary? You can search online for the AME guide from the FAA for the latest details.

BTW- did they put in a syndesmosis screw? If so, these are normally taken out fairly early. This could be why you lack dorsiflexion. The rest of the hardware generally stays in unless it is bothering you in some way.
 
He did install 2 syndesmosis screws linking the tib and fib, they're coming out in about 6 weeks. At this point I'm not cleared for anything weight bearing without the boot. Getting up in the middle of the night to go to the bathroom without it on was specifically called out as something that would be a poor choice.

I can get in, I can work the rudders, I cannot work the toe brakes for obvious reasons but I can use the center brake handle and I can get out. Hence the question about what the range of motion needs to be. I may be better than 0 to +30 now both feet seem to move similar amounts, with the caveat that the broken one has more discomfort than the good one for the same movement.
 

Attachments

  • 0010067628_CR_6025.665113.1_20140306_001.jpg
    0010067628_CR_6025.665113.1_20140306_001.jpg
    516 KB · Views: 156
The syndesmosis screws will limit your dorsiflexion. Some docs like to recommend range of motion out of the boot at this time, like tracing the alphabet with your foot.

You will need more time after the syndesmosis screws are removed. The remaining holes are sites that could lead to another fracture if you stressed your fibula.
 
The X-rays look good (without seeing the other views) need to be sure the two farthest screws aren't into the distal tib fib joint. Also, did they make a second incision medially? I recall that your medial side was widened, suggesting your deltoid ligament had flipped into the joint.

Good luck.
 
That's correct it was widened and its been brought back together. The mortise looks normal again, or it did 2 weeks ago before I started doing weight bearing work on it.

The the pantarflexion and dorsiflexion exercises are out of the boot, I'm also doing 10 minutes a session on the bike at PT twice a week.
 

Attachments

  • 0010067628_CR_6025.665113.1_20140306_003.jpg
    0010067628_CR_6025.665113.1_20140306_003.jpg
    729 KB · Views: 178
  • 0010067628_CR_6025.665113.1_20140306_002.jpg
    0010067628_CR_6025.665113.1_20140306_002.jpg
    595.8 KB · Views: 179
airheadpenguin said:
OP again, following surgery and staying off of it for a few weeks my orthopedist cleared me to get back to walking in one of those orthopedic boots which I'm sure means I'm still medically deficient.

The question I had is, as I understand it the issue with with range of motion and being able to not use the boot for support. So how normal does the ROM have to be, keep in mind I'm in my 30s and have roughly the ROM of 0 degrees (perpendicular to the leg) to about 30 degrees (foot pointed down)
Click to expand...
If you're asking where you need to be ROM wise to be legal to fly PIC, IMO that's when you believe you can operate the brakes (on the ground) and rudder pedals without a pain or ROM induced limitation. I don't mean total lack of pain or original ROM, just no significant interference with your ability to control the airplane.
 
Last edited:
You'll know when you can fly. As noted by others, when you can work the rudders and brakes and can get in/out of the plane by yourself, you are probably good to go. I'm assuming you're not on prohibited pain meds.

My left ankle was fractured and dislocated a touch over 40 years ago when an idiot in a 1968 Ford Mustang ran a stop sign and hit our motorcycle broadside. The end of the bone that creates the outside bump in your ankle (hey, I'm an engineer, not a doctor) was reduced to a bag of bone fragments. The end of the bone that creates the inside bump was broken off as the foot dislocated to one side. The outside bump was worked back into something functional (I believe the doctor said something along the lines of "I hope this works") and the inside was stabilized with a pair of screws (that are still there today). The doctor wasn't just another ER doc on call that night, he was a well respected local ortho surgeon who was also the team physician for the WSU football team. He was supposed to be at a party my parents were attending, but didn't make it for some reason.

He never would show me the pre-op films. Only the post-op. My dad, who taught orthopedic surgery at the veterinary school at WSU, did see the pre-op films. His comment was that the surgeon did a great job with what he had to work with.

40 years later I still have limited range of motion in my left ankle. But, I can operate the rudders and brakes with no difficulty. And this was reported during my first medical back in 2000 and required no paperwork. I guess all this rambling is designed to make you worry less. Heal up and you'll be back in the air.
 
OP here, Tuesday (2 months to the day) after breaking it I got cleared to walk around out of the boot. I'm happy to report that I can drive without an issue aside from some extra swelling from use.
 
dnhill said:
From previous experience, you should expect swelling for up to a year.
Click to expand...

My ortho said it would hurt for a year, he was right. Had the grooviest edema ankle was puffy seemed like sillyputty under the skin.
 
dnhill said:
From previous experience, you should expect swelling for up to a year.
Click to expand...

Only a year? Mine comes and goes after 40 years.

ClimbnSink said:
My ortho said it would hurt for a year, he was right. Had the grooviest edema ankle was puffy seemed like sillyputty under the skin.
Click to expand...

If I don't abuse it my ankle is fine. But if I spend too much time on my feet, or walk too far (what is "too far" depends on what shoes I'm wearing) I'll be stiff and sore for the next day or two. I guess it all depends on how badly your ankle was torn up in the first place.
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top