Non-Displaced Distal Fibula Fx? (Full Version)

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connelja -> Non-Displaced Distal Fibula Fx? (May 5, 2008 4:51:28 PM)

I was recently contacted by a close friend from High School who was put in a recent delimma. 3-4 days ago he was walking and he severly "rolled" his ankle on a curb. However, he recently changed jobs and his new health insurance has not kicked in yet. He tried to gut it out for a few days (with no improvements) and not see anyone (MD,PT) but after talking to him he was positive for Ottawa Ankle rules and I suggested he get a radiograph. He went to a local Urgent Care (I know not much musculoskeletal training, if any) and had an radiograph which was positive for a non-displaced distal fibula Fx. He was instructed to contact a local Orthopod and was informed he would probably be casted for 2-4 weeks. He was also sent home with crutches and instructed NWB on that extremity.
He has not made an appointment with the Orthopod due to the financial concerns. He has now informed me that he is thinking of maintaining the NWB precautions for 3-4 weeks, buying an aircast to immobilize the joint and wants to know my opinion on this. 
Now this put me in a delimma, do I instruct him to visit the Orthopod and take a hit to the wallet? Do I tell him that he will probably be OK if he stays NWB and immoblizes the joint? (I am looking at this with practical and possible legal concerns)
Any thoughts or help with this would be greatly appreciated.
Thanks, James
   



Shill -> RE: Non-Displaced Distal Fibula Fx? (May 6, 2008 8:16:34 AM)

Rock  < You  >  Hard place

If this is a true friend, you should not be worried about legal concerns. 

Bottom line is, you present both scenarios to him, he is a grown adult, and can make an informed decision.  It should not be your dilemma, but rather his.  You recommend more strongly the visit to the orthopod, or have him at least call the urgent care doc who saw him to get the opinion of how much that is truly necessary to see the orthopod, given the financial situation. That way, you stay out of it as much as is actually possible.



VagusX -> RE: Non-Displaced Distal Fibula Fx? (May 6, 2008 1:36:52 PM)

Legal concerns and close friend should not be put into the same sentence.   Ankle fractures are common and easily treated, but nobody here know the whole picture. 

If my good friend came up with the same situation, I would put him in an aircast and tell him to stay on crutches for 4 weeks.



bonez -> RE: Non-Displaced Distal Fibula Fx? (May 6, 2008 2:13:19 PM)

I believe that there is a small risk for non union so if you opt air cast firmly insist on the non weight bearing application. Since it is non displaced there should be little long term negative out comes. 30 years ago this kind of injury was casted and turned loose. I believe that if pain is improved at 4 weeks you could graduate to partial then full weight bearing over the final two weeks as these injuries are usually 6 plus week recovery.



connelja -> RE: Non-Displaced Distal Fibula Fx? (May 8, 2008 12:01:03 PM)

I appreciate everyones thoughts on this. After posting message I recieved advice from a local orthopod. He informed me that even though the Fx is not displaced at this time, the risk of displacement is there and the costs of possible surgery, if it does displace, are obviously much greater. Given this info. I instructed my "clumsy" friend to see a local orthopod, which he did. The films were examined more closely and he had medial and lateral malleoli fractures and he was placed in a cast NWB for 6-8 weeks. Again thanks for everyones' input and I guess playing it safe may be the way to go. 



Boaco -> RE: Non-Displaced Distal Fibula Fx? (May 9, 2008 6:55:38 AM)

Hi Connelja
The issue of legal liability is one that you can not dismiss lightlly, even a friend could lead to significant  problem.

My advice would be to refer  him to the orthopaedic  surgeon.
For your personal knowledge, without seeing the x-ray it would be difficult to make a sound diagnosis.
The fracture could be just a distal avulsion, that is being treated too conservatively or a something more serious treated incorrectly.

A lawyer will not give advice to a client unless a retainer is in place, the same should appy to a physical therapist he/she must be your patient.
Good luck.




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