Seth Nickell

A slivver more than two weeks ago I “sprained” my left ankle playing barefoot soccer. The ankle felt like it was getting better, but as swelling receded my foot felt awful. I could step on it, but the first few steps hurt like crazy. Other steps hurt but I didn’t have to brace myself for them. I finally caved and decided to see a doctor.

Unfortunately, as predicted, this turned out to be a very frustrating affair. I know some people like lots of choice in Doctor, etc. But I sort of like the Kaiser-Permanente (HMO? in CA) model where they have their own big buildings with everything in it. You show up, and they’ll figure out what to do with you. Anyway, I called the Blue Cross Blue Shield of North Carolina (*sigh*, since RH is based in Raleigh) advice nurse line twice. They were both confident I should go to an urgent care facility, and were basically unwilling to believe there are no urgent care facilities here.

There are tons in Conneticut, there are tons in Rhode Island, there are tons in North Carolina, and there are tons in California. There are almost no urgent care facilities in New Hampshire or Massachusetts. Some puritans probably made a law against them a few hundred years ago. Or maybe, its because human life is oh so critically important that even non-emergencies should go to the emergency room “just in case”. Or maybe its because the NE sucks in general. I dunno.

I finally decided to just drive to Rhode Island, because I really hate the thought of going to an emergency room for a non-emergency. Despite having to clutch with my hurt ankle/foot (which fortunately you don’t have to do much on an interstate… just stay in 5th), it was actually a very positive drive. I was feeling pretty blue, and driving into the sunset in the outdoors is really nice. So I drive across Massachusetts and show up at this small town urgent care center. They X-Ray my foot, and my ankle. Nothing seems wrong, which surprises them given how my foot looks. Anyway, they X-Rayed my leg and it turns out my fibula (the small bone of the lower leg) is pretty badly fractured. So they splinted the area, and told me to go to an orthopaedic surgeon.

Lovely. Very strange that the pain was in my foot. I’m still a little paranoid that there’s an occult fracture of the fifth metatarsal causing the foot pain. So the good side to all this is they gave me the X-Rays to take to the orthopaedic surgeon. I’ve been studying them and reading medical research papers from medline about what I see. I’m finding this very interesting. Ankle fractures (and sprains) turn out to be extremely varied. Looking at the damage from lots of different angles has also made it possible to reconstruct in more detail how I must have fallen.

Anyway, I don’t have a scanner but I (very appropriately) gimped an online X-Ray of a healthy ankle to be a fairly good replica of mine. I cheated a little because I made it look like my posterior projection of my left foot. The online image is, I believe, a front projection of a right foot. From other projections it looks like this may be a spiral fracture, but from this projection it looks mostly like an oblique fracture. I’m not really sure either way, they apparently often look very similar from non-axial projections. I also labelled some stuff to give bearings.

The yellow areas are the (from left to right) lateral and medial malleolus. That’s the boney bump on the left and right of your ankle. The pink area is the tibiofibular syndesmosis, which connects the fibula (smaller bone) and tibia (the larger weight bearing bone) together. Sprains are often a result of stretching this. Anyway, because the fracture is proximal to the tibiofibular syndesmosis, this is probably a suppination with external rotation (Weber B). That means the injury probably occurred with the weight leaned on the outside edge of the foot, and then the foot was rotated. It is possible that its pronation with external rotation (a form of Weber C).

So the bad news is that most Weber C injuries require open reduction (reduction is placing the bones so they align for healing). That would mean cutting my poor ankle open, and possibly even using syndesmotic screws that would have to be removed some weeks later :-/ The other problem with open reduction, besides the fact I’d need surgery, is that studies of outcomes suggest that open reduction results in a far slower recovery and goes awry far more often. With any luck its a Weber B.