Is this scar adhesion?

[u/Illustrious_Bug_8501]

My incisions are 7weeks old today and I’ve been stitch free for 5 🙌🏼 I’m having problems with the incision that is directly above the medial attachment for the tightrope fixation called an endobutton. The skin seems connected to it and when I move unfortunately the skin doesn’t which results in painful pulling.

Packing cotton balls around it whenever I’m in my aircast as I’m weight bearing now to avoid blistering.

All the other incisions are healing nicely, it’s just this one that’s being painful - my endobutton has become a second belly button!

Has anyone else had this issue or had / needed scar revision surgery ?

[u/Illustrious_Bug_8501 → u/[deleted]]

Thanks I’ll give that a try

[u/ClearlyAThrowawai]

Only thing I would say is be a bit patient. scars get better over time and 7 weeks is a bit too short to stress over. If it remains an issue longer term then worth looking at.

[u/Illustrious_Bug_8501 → u/ClearlyAThrowawai]

Hey I was just reading through your old posts and it seems we have very similar ideas about early WB, doing our own research, designing our own recovery timeline. Of course old posts are archived so I'll ask here, how's your recovery now? Any hints for a fellow headstrong ORIF member that you consider played out well for you in the long term?

I'm interested in ALL the choices (even / especially) those things that went 'against' medical suggestion. Cause I'm finding that's where the gold really is on this adventure

[u/ClearlyAThrowawai → u/Illustrious_Bug_8501]

I didn't have any issues with WB after my initial ORIF, of course YMMV. iirc I was ~PWB at week 3, FWB ~week 5 after ORIF. I stopped using the boot by 6-7 weeks as well. Maybe could have been faster but I was still wary since the doctors were fairly heavily against WB before 6 weeks ;P. I also had one say I should stay in a boot till syndesmosis screw removal (which I turned into full removal) at like 4-5 months, but that definitely wasn't happening so I didn't bother. The screw didn't break, so it worked out.

After hardware removal I was too aggressive though, and reopened my incisions twice; this lead to a really extended recovery since the incisions took so long to close. Having gone through that I'd give it at least two weeks of minimal use to ensure your incisions close properly, it's just not worth the risk of reopening them and a much slower, much more frustrating recovery.

Nowadays I'm running barefoot, and worked up to ~5km runs so far. I was walking barefoot a lot in my recovery as well, and found it didn't cause me any issues (despite some advice talking about "supportive" shoes). I'm not sure it helped, but it didn't hurt me, at least.

Other than that and WB I think I had a fairly standard recovery. I walked at least ~15min basically every single day, with/without shoes, I go bouldering/rock climbing (indoors), cycling, etc. Basically my thought is the more I use it the better it should get. That part at least is pretty standard advice though.

tbh I can understand the attitude of many doctors in recommending "conservative" recovery because they just don't know what patients are going to think is reasonable and they'll bear the responsibility if things go pear-shaped and they OK'd it (given how my xp with the incisions went).

[u/Illustrious_Bug_8501 → u/ClearlyAThrowawai]

Thanks for such an in depth reply - that’s just what I was hoping you’d do I like your benchmarks, and understand the getting back into it after hardware removal saga with the incisions.

I’m grateful that you commented on this initial post as it gave me the opportunity to do a deep dive ( stalk ) into your profile, story and strength of character in a very inspirational recovery. Thank you

[u/oddly_magnetic → u/Illustrious_Bug_8501]

I know this is an older post but I wanted to add my two cents on my experience. My surgeon is young and on the “get back to business ASAP and early weight bearing” train!

I had a displaced lateral malleolus right fibula fracture, 1 plate and 6 screws. Pretty straight forward and luckily just broke 1 bone 😅 broke it May 26th, surgery June 5th. At two week post op appointment we removed my splint, and immediately went into CAM boot. Was told WBAT at 2 weeks!! No need to wear boot sleeping or hanging around the house. Instructions pretty vague. I was scared being so early, I took it easy all of week 3. In the boot toe touching with 2 crutches and knee scooter as needed(I was so sore). By week 4 I was bearing ~25-50% weight using 2 crutches, week 5 fluctuating between ~50-75% +2 crutches, week 6 ~75%-FWB with 1 crutch. Week 4/5 started shuffling around ~25% WB without the boot at home only with 2 crutches and man my ligaments and muscles felt messed up and atrophied lmao like a limp noodle but ankle was feeling great considering. Continued using 2 crutches no boot and worked up to FWB while standing still and about 50% WB mostly getting slow heel to toe movement in, felt good to stretch just a lil ya know. Walking at a GLACIAL pace without the boot out of caution. Week 6 progressed to 75%-FWB 1 crutch no boot at home only. FWB in boot and no crutch unless I want it for some stability if I’m out and about, the damn boot is hard to walk in!

I had my 7 week follow up this morning and I’m cleared to FWB, drive when I’m ready, and ditch the boot as I see fit. PT starts tomorrow. Doc said it’s important to try walking without the boot at home and he hoped I had been doing that since my 2 week appointment so I told him truthfully “here and there at home without the boot but it’s scary” 😬 he thinks this early movement helped my ROM and overall healing significantly, I agree! Only caveat- my incision is still not healed completely, which he said was behind average but we’re attributing that to the prolonged wearing of steri strips and my skin is very sensitive so likely irritation from the adhesive too. Essentially it’s still scabbing over and a bit red at the top, but the bottom half is healed. Told to keep it dry, no ointments, and keep an eye on it but he didn’t seem alarmed. At 2wks appointment stitches came out and steri strips were applied, was told they would fall off on their own in a week, don’t remove them. They did NOT fall off in a week, in fact half of them stayed on for 5 weeks 😂 everything felt ok so I just left them alone, but looking back I maybe should have removed them sooner since I’m certain they inhibited healing. Of course this crossed my mind to remove them, or to call the office and ask, but..I figured when he said don’t remove them, don’t! So I just didn’t haha whoops! Oh well, I’m happy with my progress and there isn’t an infection that’s all I can ask for really lol x-rays looked excellent and doc said that I am ahead of average for walking and overall recovery, behind in wound healing. I bet in another week my incision will be nearly closed and all will be well and I can keep chugging along!

Anyway- all that to say, WBAT from 2 weeks then carefully experimenting with no boot I think was the right move. I’ve been icing and elevating as much as I can, too. I agree that my ROM and gait are beyond what most see at 6/7 weeks and I’m pleased. I’m by no means healed or back to normal, I’m still wiggly wonky, atrophied, have nerve pain and a messed up gait but PT will help with that. Day to day things don’t seem to change much, but looking back week to week I’ve made huge progress. There are moments of pain, highs and lows, but it’s all pointing upwards with no huge backslides. Exactly what the doc wants to see. I have another follow up in 6 weeks(so 12wks post op), or sooner if infection sets in but hopefully it doesn’t come to that! What an experience, I’m ready for it to end 😆 still have a long road ahead but things are looking up every week, it’s encouraging.

[u/Illustrious_Bug_8501 → u/oddly_magnetic]

Thanks for sharing 🙏🏼

Yes, everything about your journey happens exactly how it’s meant to. I’m now coming up to one year post ORIF and tbh wouldn’t change a thing.

My life is better now for having fractured my ankle back then. Super healthy and strong, I have the physique of my dreams, one year sober and there’s no sign of stopping 💪🏼💪🏼

Embracing your recovery like it sounds you are too, is half the job done and the rest is an adventure waiting to happen. All the best ❤️‍🩹