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Ankle fracture - severe pain 6 weeks later

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Old 26th September 2009, 04:42 AM
DDD15 DDD15 is offline
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Default Ankle fracture - severe pain 6 weeks later

My daugheter had an accident on an ATV on Aug 14th. She was x-rayed in ER and sent home with splint and crutches. Four days later at ortho. was x-rayed again and found small fracture in lower part of fibula. She was put in "CAM Walker" and crutches. Two weeks into this, pain was getting worse and she was losing sleep. MRI was done Sep. 9th and fracture on her ankle was found, the fracture higher up her fibula was looking good. She was put in non weight bearing cast and given pain meds. Her dr. said the ankle fracture did not seem "typical" as it was not healing and her pain and sensitivity in the area was making him consider RSD. She is 13 and has been missing so much school - her dr. has excused her from school for another four weeks. So, she has been resting most of the day with her foot up and no weight on it. Well, the pain has progressivly gotten worse. This is now six weeks after the original injury. She has tingling sensations from time to time and the pain is now spread up to her hip. She says the pain is about a 7-8 on a scale of 1-10. The pain is constant. The bad news is her dr is on vacation and I wasn't able to talk to him today. He won't be back for 10 days so we will definitely have to see another dr. The dr. taking his calls is not someone we feel comfortable with. I tried to get her in to another dr today (Friday) with no success. My questions are - does this sound like we need an emergency room visit? I would think all they will do is give her meds? Should we see a neuro for a RSD diagnosis? Would nerve damage show up on MRI? Could any other fractures/problems have been missed on MRI?

Thank you for ANY input you can give me.
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Old 26th September 2009, 01:39 PM
FootDoc FootDoc is offline
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Default Re: Ankle fracture - severe pain 6 weeks later

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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If she is suspected of having RSD, and certainly the comments you've made . . . increasing pain, tingling, proximal progression of symptoms... (especially if she also has cold clammy skin which is mottled in appearance) may be generally consistent with that, she needs a definitive diagnosis and prompt and aggressive treatment by a specialist experienced with this often serious problem. The condition is not one which is very well understood at its basic levels, and you may have difficulty finding a doctor really competent in its treatment. Often pain management specialist with a good background in problems related to the sympathetic nervous system take these cases. But I would emphasize the need to obtain a specialist who really knows what he is doing as quickly as possible, both to establish the diagnosis and treat appropriately.
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Last edited by FootDoc; 26th September 2009 at 01:41 PM.
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Old 26th September 2009, 03:09 PM
DDD15 DDD15 is offline
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Default Re: Ankle fracture - severe pain 6 weeks later

Thank you for your reply. Is RSD the only thing that comes to mind with these symptoms? I keep hoping that there is something else that was overlooked. The sccident she was involved in was pretty severe. Her foot slipped of the peddle and was really hit hard and pushed the front of her foot backwards towards her heel - I guess this is plantarflexion? Also, what kind of doctor should we be looking for at this point? We live in Texas.
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Old 26th September 2009, 05:06 PM
FootDoc FootDoc is offline
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Default Re: Ankle fracture - severe pain 6 weeks later

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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What else might come to mind cannot be responsibly offered on the basis of only a lay report of symptoms, and I would leave such a question of differential diagnosis in the hands of an examining doctor. But based on what you have said and the comments of the child's current attending, I think that RSD may well be considered. The degree or severity of injury is not relevant to such a finding. I offered my opinion as to considerations in the search for an appropriate doctor in my initial response.
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