fracture

[lyki]

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Curious what thoughts are about elderly patient who has a stable nondisplaced distal fibular fracture? At about twelve weeks, there's still swelling and maybe there's starting to be trabeculation but no significant callus. Pain not much of issue but patient not doing much walking. Finds the CAM walker bulky and hard to walk in. Continue the CAM and return in a month, discontinue the CAM, WBAT, and start short course of physiotherapy, or send to orthopedics?

 

[RUOkie]

Are you judging by CT or plain film? If I see some, but not complete healing on x-ray at 12 weeks, then get the CT. Often you will see a good union.

 

[PMR 4 MSK]

Likely needs a bone stim and a bisphosphonate along with Ca++ and Vit D supplement. I would get ortho involved, just to CYA.

 

[DistantMets]

If the fracture is at or above the level of the ankle mortise (Weber B or C) the syndesmosis may have been affected making the ankle unstable. These usually need surgery. I agree with the CT and would not do PT until you've ruled out a non-union. If she's elderly, her healing time might be slower, but I'd think hard about getting an ortho opinion 3 months out.

 

[ampaphb]

Likely needs a bone stim and a bisphosphonate along with Ca++ and Vit D supplement. I would get ortho involved, just to CYA.

bisphosphonates???

 

[PMR 4 MSK]

bisphosphonates???

No I can't quote you any literature, just what I see the ortho trauma guys doing here.