What happens after a fracture heals?

December 1, 2006 3:39 PM

I broke my leg. What happens when the cast comes off?

I broke the fibula, about 30mm above the lateral malleolus (the sticky outy ankle bone). It was as a result of a martial arts accident, where I was thrown very powerfully by an instructor. My foot stayed planted on the floor, while my upper body rotated. The injury mechanism would have been similar to a downhill ski-er having their foot rotated in a fall when their bindings didn't release.

X-rays at the time and a week after showed that all the bits were pretty much in the right spot, and as a result the orthopaedic surgeon decided not to operate, but to treat it conservatively ie plaster and rest. She said at the time that there was nothing about the fracture as an injury or me as a patient that gave her any reason to think that it wouldn't heal fully.

I'm at week four of six weeks in a fibreglass cast. What I want to know is what to expect in terms of mobility, pain etc when the cast comes off. FWIW, I'm male, 35, 140 lbs and otherwise quite fit.

posted by tim_in_oz to health & fitness (16 comments total)

I spent two months in a cast when I broke my lower leg at age 13 - the first month or so in a full leg plaster cast and the rest in a fiberglass lower leg walking cast. I also had a fairly simple break that healed well. It took a few days to be able to walk in my walking cast because my leg had atrophied significantly, and when I got the second cast off I went through another couple days of unsteadiness. There was no serious pain after the cast came off. My skin was pretty gross. I was restricted from sports for the next few months.

Invest in lotion and a loofah, keep your crutches around for a while, and heed your activity restrictions (maybe no martial arts for a while). Your atrophied leg muscles will firm up again fairly quickly just with regular walking and going up stairs and stuff. If you have pain that isn't fixed by an Advil, something isn't right.

-ianad,ymmv,etc-
posted by thirteenkiller at 3:51 PM on December 1, 2006

I broke my fibula when I was 23 (and pregnant) and had a cast for 6 weeks. Afterward, there was mild pain for a while, and moderate pain for a coupla years when I inadvertantly twisted my ankle too much the wrong way. Now (at 39) I have trouble remembering which ankle it was.
posted by b33j at 3:53 PM on December 1, 2006

I'm 37 and broke my leg in three places eight months ago nearly to the day, just about where you broke yours. I am not athletic but am a serious walker and hiker.

I got surgery and have screws and plates installed, but did not have a cast. Today, my mobility is 100% of what it was before my accident. If you are a fit male, the odds are strong that you will suffer little or no lasting effects, although the chance of you getting arthritis in your later years has tripled (or more).

That said, the long-term ramifications of a broken leg vary for everyone. Some people with my injury never fully recover, and others recover more quickly than I did.

Immediately after you get the cast off you may well need one or more crutches for a few weeks to a couple of months; it took me three full months before my doctor allowed me to be fully weight-bearing on my leg. This is normal. If you can afford to, get physiotherapy; it will help. And I would recommend walking as much as you can and using pain as your guide: when it hurts more than is comfortable, rest.
posted by solid-one-love at 4:14 PM on December 1, 2006

It'll smell like cheese.
posted by nathancaswell at 4:21 PM on December 1, 2006

When my cast came off, my leg was a little weak, but it was functional enough to walk right away. I sometimes felt a little bit of sharp deep pain, but nothing that would prompt a physical response (i.e., I would not wince or vocalize, or even favor the leg much).

The doctor told me not to do anything more strenuous than a 300m walk per day for the first little while — a week or two I think.

All told, the leg is probably the best bone to break. At separate times, I've broke my wrist and little finger. Both were tortuous experiences compared to my leg. I broke my little finger (boxer's fracture) almost 15 years ago and it still causes me pain once in a while.
posted by clord at 4:45 PM on December 1, 2006

I broke almost the exact same place 3 years ago. Same advice from Dr... no surgery, just a cast for 2 months. Upon removal of the cast, I underwent 4 weeks of physical therapy to get complete movement of the area. (Complete being about 95% of where I could move it before). Other than hurting like hell when it is going to rain, and a bit stiff in the morning and night... no problem. I'm fairly fit- walk a couple miles a day. YMMV.
posted by bytemover at 5:23 PM on December 1, 2006

I'm currently in an arm cast for broken wrist and hand. It comes off the 19th. This question interests me. Any hygiene advice?
posted by sourwookie at 5:29 PM on December 1, 2006

Hygiene advice for after they take the cast off? Soap and warm water should do the trick. If you're asking for advice for now, then the obvious things like try not to get it wet, etc, but if I understand it correctly, the smell comes from dead skin accumulating under the cast and so there's really very little you can do about preventing it. It's not like it's hard to wash off.

Other hygiene advice: try not to wet your pants when they saw the cast off. It is kind of scary no matter how many times they tell you that the saw won't cut your skin.
posted by nathancaswell at 5:55 PM on December 1, 2006

Last year, in early October, on the next-to-last day of over three weeks spent rambling around Europe, I tripped off a curb, somehow (in Mainz, down near the Rhine) and broke my fibula, too! A clean fracture. The German doctor who fixed me up with a cast & crutches said for three weeks, no weight on that foot. I almost made it, about day 19 swelling made it so painful I visited the doctor back home who cut off the cast and gave me instead the flexible Velcro boot. I kept it on mostly for the next couple weeks, declaring independence from the crutches finally around week five, started walking and then tentaively running on the treadmill about the third month, running back at my usual two miles every other day by maybe the fourth month? Whatever, I'm completely recovered now.
posted by Rash at 6:10 PM on December 1, 2006

Once the cast comes off, you're going to find that your leg is covered with a thick and smelly layer of dead skin. It's kind of gross.
posted by Steven C. Den Beste at 6:18 PM on December 1, 2006

I've broken my right fibula twice -- both times a bit lower than your break. As has been said, walking was a bit awkward at first, but it didn't take me long to get back on track.

One thing that was difficult for me and got easier with practice: standing tiptoe on my right foot. My orthopedist anticipated this, you may want to talk to yours if you are concerned.
posted by gnomeloaf at 6:19 PM on December 1, 2006

i'[m gonna echo everyone else ... though i actually broke my leg in the skiing accident you described. couldn't really walk on it for a week or two after the cast was off. after that, it was fine.

the saw they use to take it off will freak you out--it's fast and loud, but also really dull--it won't cut skin. the nurse that did the sawing actually demonstrated this on the palm of her hand. one problem i did have is the fact it tickled really bad, but then i am hyper ticklish. the nurse kept on thinking i was reacting to the saw due to me thinking it hurt. it was really hard for me to keep my leg still.
posted by lester's sock puppet at 6:35 PM on December 1, 2006

Just plan to get right home and take a long shower. As stated above, it's going to be nasty/ stinky. Initially (this was my hand) I had no range of motion and it hurt worse than when in the cast. Doctor said it would need a couple more months to heal properly, he was 100% correct. Getting the cast off didn't mean I was healed.
posted by vaportrail at 8:30 PM on December 1, 2006

Broke my fibula about 13 years ago, with extensive joint damage, and have a plate/6 skrews in one leg.

The stuff these guys have said is dead on. Nasty dead skin cells to wash off gently, some minor pain that goes away, having to be careful walking for some time. It took me a long time to totally forget about it while walking, but that hyper consciousness about your leg will go away too with time.

My one recommendation would be to make sure that you get some sort of physical therapy afterwards, even if it doesn't seem so bad. I have much less movement in my broken foot/leg than I do in the other, and it has affected how I walk to the point that I get terrible shin splints in the other leg if I don't use the right kinds of shoes. Physical therapy is key, I think.
posted by gemmy at 10:22 PM on December 1, 2006

You might also have a fair bit of muscle wastage. I broke my ankle last year and was in plaster for 3 months as a result. When that came off my entire lower leg had shrunk to the same size as my ankle - which was rather alarming. I guess being in plaster for less time should make this much less dramatic in your case!
posted by prentiz at 12:56 AM on December 2, 2006

Thanks to everyone who has posted. I feel a little more informed about what is going on down there. While the cast is on, and once the initial pain is gone, it's kinda hard to know where you are at in the healing process. You've all given me some insight into where that might actually be. Cheers!
posted by tim_in_oz at 12:56 AM on December 2, 2006