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Sports Medicine

Fractured Fibula with Displaced Tibia?

11/04/2010

Question:

Four days ago my 15 year old son was injured during a football game. He was apparently hit on the side of the lower leg and his ankle was rolled over. He was taken to the local hospital (the game was away), x-rays were taken, he was fitted with a boot, told to stay off the leg, and was sent on his way.

Yesterday he met with his team doctor who referred him to the home-town Orthopaedic Surgeon. Another set of x-rays were taken. I was called, and was told that my son needed surgery for a tibia with a displacement of 2mm. The apparent reason for the displacement without fracture was said to be due to the connective tissue having been damaged during the accident. I immediately asked every question I could, but did not get any answers that made me feel comfortable with just accepting surgery. At one point he told me that this was not even a questionable issue. "Surgery had to be done, and any MD I would talk to would tell me the same thing", he said. No MRI nor CT Scan was done.

I need to clarify that I have been out of town during all of this, so I`m getting it all by phone. I immediately begin to do my homework. I start realizing that I have not come across a single instance of fractured fibula with displaced tibia in several hours of research. I call the original hospital that did x-rays. Turns out they saw things differently. The diagnosis after x-ray read, "Fractured fibula with no displacement. Possible, minimal subluxation of the talus relative to the tibia. No other abnormalities present."

What is going on here? Was a mistake made? If so, why? Is this a case of a surgeon trying to find a reason to do surgery? Should we just have the leg casted and let it heal, or should we see a specialist first? I am highly irritated by the idea that a surgeon may have been trying to convince me to have unnecessary surgery on my son.

Thank you for any info, input, and help.

Answer:

With the number and nature of questions you have and the fact there continues to be uncertainty, it would certainly seem reasonable for you to consult with another orthopedist. You should take both the initial and subsequent set of X-rays for comparison, to clarify why there seems to be a difference of opinion about which structures were injured, whether an MRI or CT scan is necessary if any doubt remains, and what is the most appropriate treatment.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University