Patient Details
- Age: 19 years old
- Presenting Complaint: Pain and swelling in the lower leg following a skiing injury.
Background
A 19-year-old girl presented to Access Ortho after returning from a ski trip to Japan. During the trip, she attempted a ski run that was more advanced than her usual level of ability. While skiing, she took a tumble, landing awkwardly and she experienced immediate pain in her lower leg. An X-ray taken in Japan revealed a fibular fracture. Due to the nature of the injury, a back slab (a temporary immobilisation method) was applied, and she was instructed to wear it for the duration of her return flight home to Australia.
Upon arrival, the patient was unsure who to see for further care. Her GP referred her to Access Ortho for more comprehensive evaluation and management.
Clinical Presentation
The patient presented with moderate pain and swelling over her lower leg, specifically around the area of the fibula, just above the ankle. She reported difficulty bearing weight on the leg and had limited mobility due to pain. There were no signs of compartment syndrome (no excessive pain, swelling or loss of sensation) and her neurovascular status was intact, with normal pulses and sensation in the foot.
The patient mentioned that the pain had been constant since the injury, with occasional throbbing that worsened with movement or weight-bearing. She had been instructed to keep her leg elevated and to use crutches during her flight, which helped reduce swelling but did not alleviate the pain entirely. The temporary cast was offering little support at this point as it had started to loosen.
Assessment and Examination
Upon examination, the patient’s leg showed swelling and tenderness over the distal fibula. There was no open wound, but the pain was exacerbated with palpation around the fracture site. There was a decreased range of motion in the ankle joint due to pain, and she was unable to bear weight on the affected leg.
The initial back slab was barely intact and no longer suitable for immobilisation, as it provided limited support and protection for the fibula. The patient had photos of her x-rays from Japan, however the medical team at Access Ortho decided to refer for further x-rays to evaluate the position and healing of the fracture and the extent of injury.
Radiology
The patient underwent a set of X-rays to assess the fibular fracture. The imaging confirmed the presence of a non-displaced fracture in the distal fibula, which was consistent with the earlier X-ray taken in Japan. The fibula fracture was uncomplicated, with no signs of displacement or angulation, and no associated injuries to the tibia or soft tissues were noted.
Given the location of the fracture and the lack of displacement, the fracture appeared stable but required careful management to prevent any complications. The medical team was also mindful of the back slab applied in Japan, which now had limited capacity for maintaining alignment and providing optimal support during the healing process.
Treatment
Based on the radiological findings and clinical presentation, the patient was advised to proceed with the following treatment plan:
- Moonboot Immobilisation: was applied to provide more comprehensive support than the previous back slab. The moonboot ensured immobilisation of the injured area while allowing for adequate circulation and comfort. The patient was instructed to weight bear if pain allowed, as the fracture pattern was safe for this level of force.
- Pain Management: Pain management strategies included the prescription of over-the-counter pain relief medication (such as ibuprofen) and advice on managing swelling with elevation and ice packs. The patient was instructed to take medication as needed to manage pain, especially during the initial stages of healing.
- Crutches: The patient was given crutches to avoid/ limit weight on the affected leg during the healing process until she was comfortable to mobilise just in the boot. She was advised on proper use of crutches to prevent further strain on the injured limb and to maintain good posture while walking.
- Follow-Up Care: The patient was scheduled for a two-week follow-up to monitor progress. During this visit, the orthopaedic surgeon would assess for any signs of complications (e.g., displacement or deep vein thrombosis) and ensure that the cast was still in good condition.
Follow-Up and Recovery
At the two-week follow-up appointment, the patient reported a slight reduction in pain, with the swelling having gone down. The leg under the moonboot was checked for fit and any signs of wear or pressure sores. The medical team conducted a follow-up X-ray to monitor the progress of healing. The X-ray showed that the fracture was healing well with no signs of displacement, and the bone was aligned properly.
Given the stable nature of the fracture, the patient was instructed to continue with the moonboot for another four weeks, with an emphasis on avoiding high-impact activities such as running, jumping, or skiing until full recovery.
A final follow-up visit was scheduled for six weeks post-injury.
At the final follow-up, the moonboot was removed, and the patient was cleared to resume normal activities. She was advised to continue with rehabilitation exercises, particularly focusing on ankle mobility, strengthening, and proprioception. The recovery process was uneventful, and the patient returned to her usual activities without limitations.
Conclusion
This case highlights the importance of proper management of lower leg fractures, particularly in young adults who may be eager to resume activities. The initial treatment of the fibular fracture with a back slab was appropriate for the immediate post-injury period but required follow-up care to ensure optimal healing. Access Ortho’s comprehensive assessment, further imaging, and careful follow-up care allowed for effective treatment, with the patient fully recovering and returning to her normal activities after six weeks of immobilisation and subsequent rehabilitation.
The case also underscores the need for tailored treatment plans based on injury severity and patient needs. Early intervention, clear communication with patients, and thorough follow-up care are essential in achieving a successful recovery from fractures like this one.