Gonzalez TA, Macaulay AA, Ehrlichman LK, Drummond R, Mittal V, DiGiovanni CW. This can be performed through the syndesmosis squeeze test. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Thank you for your comment as it pertains to my concern. De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR. Comparing the knotless tension band and the traditional stainless steel wire tension band fixation for medial malleolus fractures: a retrospective clinical study. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. After physio, working out at gym, and at the end of the day when edema (swelling) is at its worse is when the pain bites. You can use Radiopaedia cases in a variety of ways to help you learn and teach. 1B).13, In the frontal plane, the trochlea of the talus shows a lateral slope of about nine degrees.12 The surface of the talus forms an arched deepening from ventral to dorsal direction, ensuring a rotational stability in dorsoplantar movements.3,12, The ligamentous apparatus of the TC joint can be differentiated into the lateral (LCL), the medial (MCL) and the tibiofibular ligament complex. I am devesrated to say the least but everyone keeps getting on me for being so depressed, saying that I have to be positive. For the most part I try and just ignore the pain and maintain a normal daily life. Now swelling reduced can feel a sharpness I that i think is tge metalwork is this normal. I guess it opens and closes the blood vessels around the injured ankle. Also, after being discharged from the hospital a couple days later I caught a fever and flu/cold that lasted a week and a some change. The biggest cause of my pain pre-and post up was the casts. The ePub format uses eBook readers, which have several "ease of reading" features Bad injury be patient. The influence of timing of surgery on soft tissue complications in closed ankle fractures. Thank you for a very informative site. At 22 years old on the street is no way to be with this injury. As for my own experience, man this sucks!! Results of ankle fractures with involvement of the posterior tibial margin, Posterior malleolar fractures: changing concepts and recent developments. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST. Observer variation in the radiographic classification of ankle fractures, Die Verletzungen des Oberen Sprunggelenkes. Each one seemed to improve my ROM. Kneeling scooter was a life saver after the first week and I could tolerate moving the booted leg. Should also state that broken ankle had been sprained badly (week+ on crutches) at least twice previously. Carter TH, Oliver WM, Graham C, Duckworth AD, White TO. So my doc ordered nursing. This has been a long slow process but Im getting there. If it is only nausea you get when taking some pain killers, take them with food &/or anti-nausea medication. what does ODG say for post-op PT after ORIF for a tri-M Fx ? My knee scooter saved my mental health, I used it to grocery shop, get safely thru my pool. I went meticulously through a penny collection and found a 1943 steel penny, but in the end i had to admit to my husband that it was a waste of time because even if all the wheat pennies I found were worth 100% of their value its still just two cents. I slipped on the ice on January 10th and suffered a trimalleolar fracture and dislocation. I think this article does a great job in helping us realize what a slow process it is to recover from an injury like this. two days get stitches out and get removable cast so i can start showers yeah. I had several ankle pops probably scar tissue letting go, not painful but weird. Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation, Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position, Incidence of peroneal tendinopathy after application of a posterior antiglide plate for repair of supination external rotation lateral malleolar fractures, Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. The pain is pretty bad when I try although I have slowly been able to put more and more weight on it. I would appreciate any feedback on how long narcotic pain meds are generally used. Fibreglass cast removed 9 May. The treatment for a bi or trimalleolar fracture begins immediately. I have a feeling of resistance in the front of my ankle when bending. the doctor told me i had a tri mal fracture and would need surgery the next day(Wed). Parker L, Garlick N, McCarthy I, Grechenig S, Grechenig W, Smitham P. Screw fixation of medial malleolar fractures: a cadaveric biomechanical study challenging the current AO philosophy, Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws, Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures, Modified tension band wiring of medial malleolar ankle fractures, Tension band fixation of medial malleolus fractures. (D) Oblique magnetic resonance image at the level of the tibiotalar joint with distal anterior tibiobular ligament (ATIFL) (3) and the distal posterior tibiobular ligament (PTIFL) (4). What a horrible special fraternity to be a part of, So many kindred spirits telling their stories and reading the encouragement for full recovery is great! I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces. I was distraught with the severity of the injury.-didnt feel well to do much, worried about future etc I found hiring a knee scooter was my saviour. In younger, higher-demanding patients, arthroscopic-assisted open reduction and internal fixation might improve the outcome, but studies are needed to identify patients who will benefit from assisted surgical care. 8/22-2 wks post op, cast gone, given Boot and aircast on sprained foot. Dont let the stress win. I know I know. Have had Physical Therapy which did help. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia. It is important that physical therapists understand the surgery each patient went through, in order to help them through the recovery period and help them feel comfortable easing back into weight bearing on the involved extremity. Started physio but just ankle stretching. I fell and dislocated my leg and had a trimalleolar fracture on December 17. The ER docs and nurses were dumbfounded. off pain meds 3 days after sugery nurses were impressed i was off of them so fast. Rest it a couple of days then move on and up. When and how to operate the posterior malleolus fragment in trimalleolar fractures: a systematic literature review, Trimalleolar fracture with involvement of the entire posterior plafond, A surgical approach to posterior pilon fractures, Posterior fracture dislocation of the ankle: technique and clinical experience using a posteromedial surgical approach. The atrophy is almost inevitable and will be one of the main reasons that the total time for rehabilitation following this type of fracture can last longer than one year! Elevating it in a sweet spot is key. Thanks for the encouragement! Those screws can often snap when people start to weight bear so are often removed prior to progressing to weight bearing. Ive been extremely fortunate to have the help that I have had, but its still tough. Verhage SM, Hoogendoorn JM, Krijnen P, Schipper IB. I still do the ankle exercises prescribed by PT and most days I do a 40-minute full body weight routine. Trying to stay positive, but continue to worry about my job and future fun. The incisura tibialis is formed by the anterior (Chaputs tubercle) (1) and posterior tubercle (2) of the tibia. Getting out of the house is crucial. This is after 2mo.s since accident. Physical therapy and Occupational therapy. Orthopedists must be specific when documenting fracture repair because CPT's index breaks down the ankle fracture codes into six types: lateral, medial, bimalleolar, trimalleolar, pilon/planfond or posterior malleolus. The patient can perform limited core, hip and knee exercises in an attempt to prevent excessive atrophy due to the non-weight bearing status. Jonas SC, Young AF, Curwen CH, McCann PA. Functional outcome following tibio-talar-calcaneal nailing for unstable osteoporotic ankle fractures. Regarding the length of the fibula, the articular portion reaches further in distal direction in comparison to the medial malleolus. Im almost 100% dependent on my hubby who takes care of me, our baby, himself, his job, and our home I feel like such a burden. I developed the blisters after the surgery and caused pain under the cast. It makes me feel so much better and accomplished. I keep my ankle raised above my heart and ice pack it. Suffered a trimalleolar on feb 17 , going to see Md tomorrow for X-rays and see about upgrading weightbearing . In my case the swelling was so bad I stayed in a back slab cast and skipped going into a fibreglass cast and went into the CAM boot which I hated , I had my last surgery about 6 weeks ago , recovered for a couple of days and sought out a quality Physio Therapist whom I am very happy with , this to me is one of the most important facets of recovery , finding someone you are comfortable with because they will push you to near on breaking point for your own good. Go back to the surgeon or ER & get it changed. This is wonderful informative site, which I have found most helpful. My foot was snapped back and literally was hanging. i hope everyone has an amazing day! Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Open fractures in the elderly: the importance of skin ageing. I rarely take pain meds anymore. The current literature strongly advocates the operative treatment of ankle fractures involving the posterior malleolus. A bi or trimalleolar fracture is extremely severe and will incapacitate a person for an extended period of time. The ankle joint proper is made by ligamentous connections which connect the distal tibia and distal fibula to the talus near the patient's heel. its been 12 weeks since my surgery. Trimalleolar Fracture 1. in just a few more weeks I will hit my 4 month mark of being off of work . The fractures are classified as infrasyndesmotic, transsyndesmotic and suprasyndesmotic with further subcategories based on the presence or absence of medial or posterior malleolar injuries. Bimalleolar or Trimalleolar Fracture Physical Therapy protocol WEIGHT BEARING ORTHOTIC DEVICES RANGE OF MOTION GOALS EXERCISES 0-2 weeks NWB SLS None Decrease pain and swelling Wound healing N/A 2-6 weeks NWB SLC None Decrease pain and swelling Fracture healing N/A 6-10 weeks PWB CAM Boot AROM Decrease pain and swelling Gait training AROM AAROM . My biggest lesson from all of this has been to say yes when any help is offered. In October 9th I fell down some stairs and suffered a Bimalleolar fracture to my left ankle. The addition of the proximal fibula shaft fracture to the radiological findings above would classify this pattern of injury as a Maisonneuve fracture (high Weber C). It was far too damaged. At 12 weeks I am able to walk in cross trainers, full-weight bearing, around the house. Inmans joints of the ankle. I was in wheelchair so PT gave me ROM exercises that put me ahead of game and arm strengthening, which I sorely needed! Authors Patrick Pflger 1 , Karl-Friedrich Braun 1 2 , Olivia Mair 1 , Chlodwig Kirchhoff 1 , Peter Biberthaler 1 , Moritz Crnlein 1 Affiliations In clinical practice, the evaluation of soft tissue status is still an important piece of information and can lead to a delayed surgery in case of excess soft tissue swelling.66 Latest studies showed no difference regarding different time categories and further studies are necessary to determine the best timing of surgery. Im hoping the swelling will go away altogether. Antibiotics since the patient is at risk for sepsis or infection there is a need to take antibiotics to prevent it. Im going to keep a positive mental attitude in place, look for the good not the bad, and be willing to laugh at myself because it appears that I will look like a clumsy dork for quite some time! I had physical therapy (which was very helpful) Went to the Grand Canyon on June 2nd for our 50th wedding anniversary (airports were great to provide a wheelchair & assist). Good luck to you all, and DO NOT get discouraged. Ive been fortunate that my office offers short and long term disability which was approved without issue. Focus on the children who have disabilities they just ignore and muscle thru, the Special Olympic ATHLETES who manage to do way more than I will ever do, impaired or never hurt. Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. I am now at 11 weeks and it has been miserable. I have been in physical therapy since week 5. Learn more about us on Yelp, Avvo or Google. I am a practicing neurologist and want to get back to work. I have two plates and thirteen screwsvery painful. I have a plate with 6 screws on the outer part of the ankle and 2 screws on the inner ankle. I was not prepared. Let them help. It requires lifting , and Im in pain myself ! Surgery delayed 2 weeks due to swelling. After my post op appt I was put in a CAM boot. Clinical outcomes and trans-syndesmotic screw frequency after posterior malleolar fracture osteosynthesis. They havent a clue. Hi I have a trimellior fracture from an obstacle race trying to be fitter lol. If the numbness would just go away, then Id be a happy camper. My thanks to everyone for sharing their stories. Andersen MR, Frihagen F, Hellund JC, Madsen JE, Figved W. Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury, Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device. On the distal end of the Tibia and Fibula a lump of bone develops into a malleolus or malleoli (singular). The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. Contd. Rder BW, Figved W, Madsen JE, Frihagen F, Jacobsen SB, Andersen MR. This helps a lot. Email: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (, ankle joint, fibula, fracture fixation, tibia, trimalleolar ankle fractures, (A) Ankle anteroposterior (AP) mortise view of a healthy young male showing the configuration between distal tibia, distal fibula and talus. Thanks again for the share! Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Just a head up with the air cast, try get shoes with some height for you good foot. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Unstable fractures are . But i know ill be fine because i wont allow a lazy attempt at recovery.. Prayers for makng it past surgeryheart to make it thru recovery. Now have a full cast on for the next 4 weeks (shocking pink) before next appointment when I may be able to commence weight baring . My ankle was shattered & my life turned upside down but do what the doctors say, follow phyios instructions & do your exercises. Toxoids the patient had screws, plates and other fixation devices that is usually made of metal, to reduce the risk for tetanus this medicine is being taken by the patient. It does not diminish the pain, inconvenience or lossit just puts this into some perspective. Surgery is frequently delayed days or weeks if there is too much swelling. 1D). how will I be able to help my patients ! Was hoping for a short recovery and return to normal but doesnt seem likely. I started daily Physio after 2 months & followed their instructions religiously exercising several times a day. I fell and had a trimalleor fx and to go with it a butterfly fibia fracture with a chip broken under it. This has been a devastating & painful injury for me but I am thankful I can still walk, work and do nearly everything I did before. On the one side, there is a growing number of elderly patients with osteoporotic fractures and relevant concomitant conditions in which internal fixation to restore anatomical ankle joint congruity poses a particular challenge. Yes, as you all know, but for a new people reading thisthis is a complicated fracture, that may well impair our ability in some degree or fashionbut look around.it can be so much worse. To what extent is up to you. Doing physio is really important but not easy, especially if you are having pain or your ankle feels like its in a vice or against a sharp blade. The mechanism of the injury & degree of swelling will directly relate to the amount of pain we have and the instance of long term post injury pain. professionals medtronic peroneus fibularis longus muscle physiopedia tibia fracture symptoms causes treatment rehabilitation cruciate ligament wikipedia anterior tibialis tendon rupture recovery and more verywell wellness library cigna tibial . Therapy: I has a physical therapist come to me in the hospital to give me my exercises to do on my own and teach me how to use the walker on one foot. If the fracture is treated without surgical intervention, a cast will be provided, and a referral to a physical therapist will be provided almost immediately. Home two days after surgery with the boot, no weight bearing for 10-12 weeks instructions. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Feng K, Trimalleolar fracture. Braunstein M, Baumbach SF, Bcker W, Mutschler W, Polzer H. [Arthroscopically assisted treatment of ankle fractures]. This swelling can be serious, and may even cause blisters (called fracture blisters) to form on the skin. If it did turn dark burgundy (and navy blu on the sole, I would lift it above my head while back on the bed and watch the color drain out in a few seconds! This Tri. I have discovered a help network amongst my friends and family that I never realised I had. Now, 14 months from surgery, I still have minor aches, I stretch my leg/ankle daily, resumed full gym & pool workouts, cycle 25 miles, dance in girly shoes(low heels). I have a great looking scar because my surgeon is a sports specialist, he didnt make big stitches or staples. I agree with the time that they posted that it just makes me cry my eyes out. had a Trimalleloar fracture R leg, bad sprain on L. Thank God I was out with something that caused amnesia! Trimalleolar fractures are unstable fractures often associated with significant ligamentous injury and almost always require internal fixation. I have a bimalleolar fracture from a freak accident. I had surgery on 8/19 and had a plate n several screws put in. Its four weeks since fixation surgery. Trimalleolar Ankle fracture surgery performed by Dr. Paul Steinke. I was put in the external fixator aug 19. Anyone have any experience with that? Lilyquist M, Shaw A, Latz K, Bogener J, Wentz B. Cadaveric analysis of the distal tibiofibular syndesmosis. Cut those times in half to be more realistic. If two of these are involved in a fractured ankle, then it is labeled a bimalleolar fracture and if all three are involved then the diagnosis becomes a trimalleolar fracture. Fracturing any bone can be painful and take time for recovery, but fracturing an ankle is particularly challenging. Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size, Computed tomography in the diagnosis and treatment of ankle fractures: a critical analysis review. That was unbearable. As of today I can walk slowly and carefully in the boot about a half mile with crutches, 50% weight bearing. On the mortise view, the joint space between the talus and lateral malleolus and the distal tibia and medial malleolus should be equal. Im one month into this ordeal. In addition I have very thin ankles. 74 days bed confined and non weight barring was exhausting to bounce back from that and pain level was tremendous and agonizing for 2.5 months. Advertisement. I have pain every day and I stave off painkillers as long as I can until I cant stand it. Eat healthy and drink your water. Go back in 2 weeks to get stitches out of 2 incisions, X-rays & cast back on for 4-6 weeks Ive been told, & then a walking boot. I slipped and had the tri break in my left foot while on holiday. Smith G, Mackenzie SP, Wallace RJ, Carter T, White TO. Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. My resident told me to start weight bearimg on June 6th (7.5 weeks post op) and when I went back to ortho for my next check up at 10.5 weeks the consultant told me to start to weight bear. I keep it raised above my heart and ice pack it. Thank you for sharing! Not being able to do for my self is horrible. While this may seem minor, movement of the toes can keep blood clots and adhesion of the tendons from forming. but its tough not to want to put myself on my own recovery program when there is literature like this out there. After reading the comments I am concerned that he may want me to be partial weight bearing too soon. I may need to find a new normal. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry, Single-screw fixation compared with double screw fixation for treatment of medial malleolar fractures: a prospective randomized trial. One year later, I still can only walk several yards without pain, with cane, can only walk without cane around my house. Pull back gently with the towel so that your foot stretches toward you. I slipped and fell March 1 and suffered a trimalleolar fracture on my right. I didnt realise how good it would be to stand up-right and walk around unaided, to be able to stand up in the shower and not have your leg poking out the shower door, However the best feeling came from the first day I could get back in the car and finally have some independence . I got allowed to take the boot off after three weeks, as long as I wasnt moving around. I get reevaluated 9 May. the display of certain parts of an article in other eReaders. It will be a very long process to restore the strength, muscular endurance and proprioception throughout musculoskeletal system because the entire body is effected when there is a prolonged period of now weight bearing. Leontaritis N, Hinojosa L, Panchbhavi VK. I am a year and a half post tri fracure and I still swell and hurt so much. All the posts are very helpfulthank you. The therapist will determine if massage of the scar tissue is necessary so that ankle remodeling occurs properly. Is this pain normal? The bones that broke, made up my ankle,those are missing and replaced with plates and screws. Because of this I developed plantar fasciitis. Schepers T, De Vries MR, Van Lieshout EM, Van der Elst M. The timing of ankle fracture surgery and the effect on infectious complications: a case series and systematic review of the literature, Early complications in the operative treatment of ankle fractures: influence of delay before operation, Increased rates of complications in patients with severe ankle fractures following interinstitutional transfers, The influence of the timing of surgery on soft tissue complications and hospital stay: a review of 84 closed ankle fractures. I have no idea if I will ever be able to go back. And i am glad that you shared your stories. I cant imagine still using crutches 5 months in. walking on own. Have kept moving toes and legs raises but hoping to have a boot instead of cast at week 5. But the Lauge-Hansen classification system has been challenged due to a poor reproducibility and low inter- and intraobserver reliability.3639, One of the most commonly used classifications for ankle fractures is the Weber classification, which differentiates fibular fractures relevant to the tibiofibular syndesmosis.40 Despite the fact that the Weber classification system has a high inter- and intraobserver reliability, it is inadequate for multimalleolar fractures.41,42, Biomechanical and clinical research led to the development of classification systems of the medial and posterior malleolus. Your email address will not be published. Thanks Joanne This condition is considered as a unstable stage which can also lead to ligamentous injury if this parts are not properly addressed. Immunoglobulins to aid the immune system of the patients and to immunized them from Clostridium tetani products which is usually from the fixation devices. Trimalleolar fracture with a dislocation here! SMH). 1C). More cases of osteoarthritis are found in trimalleolar . Corrective osteotomy including the posterior malleolus was p. Bartonek J, Rammelt S, Kostliv K, Vanek V, Klika D, Trel I. Anatomy and classification of the posterior tibial fragment in ankle fractures. Surgery is usually the recommended treatment. A fragment displacement of more than 2 mm or the involvement of one-quarter to one-third of the articular surface on the lateral radiograph were critical indications for operative treatment.115118 CT-based classifications of the posterior malleolus were developed, since the interpretation of plain radiographs poorly assess the posterior fragment size and configuration.47,119,120 The proposed classification by Bartonek and Rammelt may be used as a guide for decision making, but important factors have to be considered. Stretching and working the mussels is something that Im still doing daily. Im walking without any aid, but have pain where the plate is on my outer ankle. Is this normal? The surgery was done on May 23. My foot swells every day,elevation works for that. Had been pestering the surgeon for weeks! Had my accident July 5 out of state and due to some really extenuating circumstances didnt get surgery until 5 days later (dislocated the whole time) It was diagnosed as a Trimaleoler but ended up being 4 breaks. I will still have 2 pieces of hardware and 12 screws in my leg. Surgery is required to fix these fracture sites. But I am determined to get back to hiking as soon as I can. Better than 3 weeks ago in bed! Ovaska MT, Madanat R, Honkamaa M, Mkinen TJ. Depending on the fracture configuration, the management and timing to definite surgery can differ significantly. At 9 weeks my doctor released me to full weight-bearing but the physical therapist suggested that I make a gradual transition. ankle is larger than my other so shoes dont fit as well. Screw, pins and plates, 6 weeks no weight bearing in cast followed by 6 more weight bearing in a knee high boot. I also get a twinge, yknow the twinge you get just before a muscle cramp comes on, did any of you feel this? I continue to do the PT exercises to gain strength back. She slammed both feet down on the break, locking her legs, just before the collision. Computed tomography is essential for classification and operative planning. Place a towel around your affected foot just under the toes. This article does a great job explaining the general recovery from bi- and trimalleolar fractures. Surgery 2 weeks after and its now been 3 weeks post surgery. Have lost some flex; still working on it. My P Therapist suggested along with my regular exercises to try a hot/cold water treatment. Tibia fracture physiotherapy rehab protocol The goal of the surgical and rehabilitative team focuses on the return of a patient to their previous level of function often in the setting of competing for short-term goals 2. Traditionally, open reduction and internal fixation of medial malleolus fractures is indicated in trimalleolar ankle fractures.44 Considering the age distribution and peak incidence of trimalleolar ankle fractures, fixation of the medial malleolus may provide an additional stability in these osteoporotic bones.50 But Hoelsbrekken et al showed that non-operative management of minimally displaced medial malleolus fractures after fracture reduction in bi- or trimalleolar ankle fractures results in equivalent outcomes.145 A prospective randomized controlled trial regarding the management of medial malleolus fractures in unstable ankle fractures is awaited, hopefully providing further Level I evidence.146, Operative management includes open and percutaneous techniques with tension-band wiring, plate and/or screw fixation. have split and spend most days resting leg splint is terrible seems like it rubbing stitches and dont sleep very well. A little aches at the endelevation and ice seem to help. Right foot touching ground but no weight bearing till 24 May. Good luck to all of us I reckon. They told me NO IBUPROFEN, but the other pain meds did nothing, so Im taking ibuprofen anyway. The patient may experience the following signs and symptoms upon bone fracture: Some of the fracture in the bones may not be necessary for imaging tests but severe complications may need for further assessment and diagnosis. I really get a buzz every time I stand and walk, even if it is a little slower at the moment. I very occasionally take ibuprofen for the pain, I usually just elevate and ice it in the evenings. i pray u have better luck than me. Wanted to see how you are doing on weight bearing without boot for your wedding? Still on crutches. You will trust your ankle again for the most part to do its job and hold you up while holding 100lbs and Ive done it and it held me. You will get better but you have to put a lot of work in it to be close to 100% wich you will never be 100% but close is pretty darn good. Hope!! Subhas N, Vinson EN, Cothran RL, Santangelo JR, Nunley JA, II, Helms CA. Complications following treatment of supination external rotation ankle fractures through the posterolateral approach. I started physical therapy at 7 weeks, one time each week. Maybe this has helped. Good luck to all of you on your recovery. And 325 mg Hydrocodone at night. I had such a silly fall resulting in a trimalleolar fracture of my left ankle. Operative treatment aims to re-establish posterior stability while restoring the size and articular surface of the tibial pilon, the stabilizing function of the posterior tibiofibular ligament and the integrity of the fibular notch.121 The quality of reduction and joint congruity are significant factors influencing prognosis.122 To achieve these goals, there are different operative strategies depending on the fragment configuration and concomitant injuries. Anyone have icky ugly scars? I got knocked over and rolled my ankle ending up with a trimalleolar fracture on Feb 11th. But it is very hard to be when I have to depend on my fianc for everything. I hope this has been helpful. I think that exercise is extremely important during recovery, I followed exactly what my physical therapist and surgeon told me to do. If anyone has any information about why it would be beneficial to have them removed verses leaving them in, I would appreciate hearing from you. I chose not to have surgery, so I was in the initial cast for 2 months, then recasted and my foot manipulated back to a neutral position then another shorter cast put on for another month. Cant do one legged toe raises yet. Plus he has a minimum of 15 yrs medical experience. tri-malleollar fracture tripping backward over a sewer cleanout. 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