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Care after an ankle fracture

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J

JMCDJ

New Member
Relationship to Diabetes
Type 2
Hi there,

I wonder if there are any medical professionals or anyone more clued up than I am to help with the following...

My father who is type 2 fractured his ankle (stable Weber B fracture) and it wasn't recognised as a fracture for 4.5 weeks. During this time he has been hobbling about, thinking it was a sprain as advised.

Two weeks ago, he had his ankle placed in a cast just below the knee to the top of his toes and I'm now concerned they should've just placed it in a boot due to the fact that it is a stable fracture and this is what I've read about the treatment of stable Weber B fractures. Am I right in thinking this is the case?

Additionally:

  • Should there have been any padding placed inside the plaster?
  • Should he be followed up by the hospital/orthopaedic team at any point due to his diabetes? He's been in the cast for two weeks as I say.
Many thanks,

J
 
Hi @JMCDJ and welcome. Sorry to hear about your dad but I think you are addressing your question to the wrong group of people. We do have some current and ex HCP's as members of the forum but I am suspecting they would be reluctant to comment. I suggest you get back to whoever decided to put on the full cast and pose your question to them. They are the only people who have all the information on which the decision was based.
 
Thanks for your reply, DocB, I wasn’t looking for specific advice just some general info - perhaps I should’ve made it clearer .

Unfortunately getting hold of anyone in the orthopaedics team is currently a nightmare.
 
Hi @JMCDJ and welcome

Sorry to hear about your Dad's fracture.

I've been in casts for years due to neuropathic damage which causes feet and ankle fractures - not the same reason as your Dad but I have been in a variety of casts for different fractures/problems - a total contact cast without padding which is close to my skin, padded casts & air cast boots that can be removed. They will have chosen the most appropriate cast for his fracture and situation I'm sure.

What follow up appointment has he been given - if any? I would keep ringing the orthopaedic clinic and hope to get through for advice on what happens next. I don't see my diabetes clinic about my foot or fractures, the orthopaedic team are aware that I have diabetes and that my skin may be more prone to blisters and ulcers so the cast is removed more often, my skin checked then reapplied.

I hope you can get some information from the hospital.
 
Hi Flower, many thanks for your reply, it’s much appreciated.

Sorry to hear about the troubles you’ve had - it can’t be nice at all.

He hasn’t had any contact with the orthopaedic team as yet and it’s been two weeks, despite us calling and email several times.

My main concern as I say is the fact that stable Weber B fractures should be dealt with by using a boot or ankle brace according to NHS guidelines which I’ve researched over the past fortnight; I’d hate for anything to happen as a result of him having a right plaster cast for the duration.

Thanks once again!
 
Is that information specific to a diabetic foot? They will have made the decision specifically on your Dad’s set of circumstances and the cast may be different to guideline recommendations for a reason.

I hope you get follow up advice asap.
 
No, specific to the type of fracture it is (Weber b), but I’m concerned there may be complications if it’s not checked regularly.
Sorry, but may I ask how often you’ve had your casts checked with the orthopaedic team in the past and whether the frequency was due to you being diabetic?
Many thanks again!
 
Following a new fracture I’m seen approx 2 weeks after the initial fracture for XRay, check bone healing & check for pressure sores/skin breaks under the cast then I’m usually left for about 4-6 weeks to try and mend. Diabetes can make fracture healing take longer than normal.

The frequency is based on needing to check on fracture healing/have an XRay. I’m told to contact the plaster room if I have any issues or pain as being diabetic increases the risk of blister/ulcers developing especially with neuropathy/ loss of feeling in the feet.
 
Hi @JMCDJ I broke my ankle in 3 places a couple of years ago (trimalleolar). I was in a lined cast for a fortnight before they could get the ankle specialist in to plate and pin me, then another lined cast for 2 weeks, checked and cast changed again at 8 weeks. Allowed to weight bear at 10 weeks and finally had the last cast removed at 12 weeks and began physio.
I hadn't at that point been diagnosed, but I strongly suspect I was diabetic then. I hope your dad makes a full recovery as I did.

@Flower I knew your feet were bad, but hadn't realised the extent. I really feel for you. Being off one's feet is so debilitating, you are so brave x
 
None other than the British Medical Journal reckons it's traditional to bung it in a below knee plaster cast for 6 weeks.

Read the attached, which a very quick Google found -
www.bmj.com

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

Objective To determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks. Design Randomised, pragmatic, non-inferiority...
www.bmj.com www.bmj.com
 
Flower said:
Following a new fracture I’m seen approx 2 weeks after the initial fracture for XRay, check bone healing & check for pressure sores/skin breaks under the cast then I’m usually left for about 4-6 weeks to try and mend. Diabetes can make fracture healing take longer than normal.

The frequency is based on needing to check on fracture healing/have an XRay. I’m told to contact the plaster room if I have any issues or pain as being diabetic increases the risk of blister/ulcers developing especially with neuropathy/ loss of feeling in the feet.
Click to expand...
Many thanks Flower, I hope your situation improves, it can’t be easy for you.
 
Vonny said:
Hi @JMCDJ I broke my ankle in 3 places a couple of years ago (trimalleolar). I was in a lined cast for a fortnight before they could get the ankle specialist in to plate and pin me, then another lined cast for 2 weeks, checked and cast changed again at 8 weeks. Allowed to weight bear at 10 weeks and finally had the last cast removed at 12 weeks and began physio.
I hadn't at that point been diagnosed, but I strongly suspect I was diabetic then. I hope your dad makes a full recovery as I did.

@Flower I knew your feet were bad, but hadn't realised the extent. I really feel for you. Being off one's feet is so debilitating, you are so brave x
Click to expand...
Wow, that must’ve been pretty painful. Thanks so much for your breakdown, it’s much appreciated. Hoping you’re feeling better now.
 
trophywench said:
None other than the British Medical Journal reckons it's traditional to bung it in a below knee plaster cast for 6 weeks.

Read the attached, which a very quick Google found -
www.bmj.com

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

Objective To determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks. Design Randomised, pragmatic, non-inferiority...
www.bmj.com www.bmj.com
Click to expand...
Hi trophywench, yes , I did actually read that previously, hence my concern considering my dad’s diabetic. Just read it again and noticed even the BMJ touches on the potential harm of wearing a cast, so I dread to think the impact wearing one could have on a diabetic patient.

Thanks again!
 
I think you are overthinking in this case, the object of treatment is simple immobilisation, whatever method you use, and a cast is as good as any other way. You can’t avoid some method of holding the ankle still, diabetic or not. A boot is more suitable for foot fractures. It’s more a question of physics than anything else.

And you can have little doubt that it’s standard practice in the hospital he attended. You might consider legal action against whoever diagnosed the strain, particularly if no X-ray was done. It’s an easy win. Worth around 5-10k at current rates. Don’t worry, doctors insurance will pay it.
 
Main salient point for my non medically educated brain here is that your dad still has proper feeling in his tootsie - so he apparently doesn't have serious neuropathy in it, neither have you said that he already has Charcot foot or any other evidence that his body doesn't heal well. So - why are you thinking that he won't?

I know I'm Type 1 not T2 and a bird not a bloke - but my bones heal just as blooming quick as everything else in my body.
 
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