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I suffered a closed, dislocated comminuted fracture of the extreme distal tibia just above the ankle joint on Feb 19th of this year with surgery the following day. I was treated with an IM nail for the tibia. The injury was caused by slipping on a hill with my foot stuck in the mud; I guess the angle and twisting motion was just right to cause the break. There was an associated fibula break at the same level as the tibia fracture and a second below my knee. The actual ankle joint was not involved at all.

I went for my 8 week xrays, and am slightly concerned at the progress, and was not really satisfied with the answers my OS provided, he seemed in a bit of a rush. On the xrays, the top fibula break showed good callus formation, but the bottom break and the tibia fracture showed no new bone growth. I was cleared to weight-bear as tolerated at week six, and have been doing so in a cam boot while using a walker. My OS did not seem too concerned about this, and did not reduce my weight bearing status. When asked the reason for the lack of bone growth he informed me that the tibia is one of the slowest healing bones in the body, and because of the break's extreme distal location, there is not much muscle and therefore not much blood supply. He said not to worry too much as it's not unusual to have no radiographic signs of bone growth at 8 weeks, sometimes it takes 10 or 12 to show. In addition, he pointed out that the lower fibula fracture showed no callus either, and since the top break was healing well that it was likely just the break's location slowing the healing progress. It is worth noting that the fracture alignment has remained good on all xrays since post op, and I do know that accepted wisdom is that the farther down the tibia you go, the longer it is likely to take to heal.

It just seems odd, as there is no pain on weight bearing, or palpation of the fracture site, and only mild soreness after stressing the leg. Movement is easy, and the leg has achieved a level of somewhat normal comfort, so it seems counter to the radiographic findings. Is it normal in very distal fractures to take longer than 8 weeks to show signs of callus? If it was not healing would there be pain and discomfort? I'd imagine there would be, and I experience none.

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  • Comments are not for extended discussion; this conversation has been moved to chat.
    – JohnP
    Apr 20 '17 at 21:47
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    Comments are for improving/clarifying the question, not extended discussion. I agree, it isn't looking for a diagnosis, the basic question is "Is it normal in very distal fractures to take longer than 8 weeks to show signs of callus". However, the question directly following that, and the extended history both make it seem like it is asking for a diagnosis. And I would caution about asking about pain levels, as those are very subjective from individual to individual depending on their pain tolerance.
    – JohnP
    Apr 20 '17 at 21:49
  • Today is my first 7 days and still swollen and hurts. it May take more than 6 weeks
    – Isaac
    Sep 22 '17 at 2:38

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