ORIF and Bone Stimulation in a Complex Work-Related Ankle Injury

Case Submitted by Dr. Marisel Medina, DPM

Board-Certified Podiatrist, Orthopaedic Center of South Florida

In this return-to-work case study, Dr. Marisel Medina, DPM, Board-Certified Podiatrist at Orthopaedic Center of South Florida, details the treatment of a healthy warehouse worker who sustained a complex trimalleolar ankle fracture while on the job. The case highlights the use of open reduction and internal fixation (ORIF), incorporation of a bone growth stimulator (EXOGEN), and a structured rehabilitation plan that led to full recovery and return to work within five months. The case underscores the importance of early surgical intervention, patient compliance, and strong communication with the care team throughout the workers’ compensation process.

A warehouse worker sustained a trimalleolar ankle fracture after falling from a loading dock while on duty. The injury involved fractures to the medial and lateral malleoli as well as the posterior aspect of the tibia, along with significant ligament involvement. The combination of bony and soft tissue damage created joint instability and made weight-bearing impossible.

The patient was evaluated within one week of the injury and underwent surgical repair shortly thereafter. Dr. Medina performed open reduction and internal fixation (ORIF) using plates and screws to restore alignment and stabilize the ankle joint. The patient remained non-weight-bearing for the first six weeks post-op and then transitioned to partial weight-bearing in a walking boot. Physical therapy was initiated in the seventh week, with a focus on restoring range of motion, strength, proprioception, and gait.

Throughout the recovery process, Dr. Medina closely monitored the patient’s progress through regular follow-up visits and imaging to ensure proper healing. Swelling was managed with conservative measures, and pain was controlled without the need for extended opioid use. The patient advanced steadily through each stage of rehabilitation and remained fully compliant with postoperative guidelines.

By week twelve, the patient was walking independently with minimal discomfort and began a light-duty return-to-work program. At week twenty, after completing work conditioning and demonstrating functional readiness, the patient was cleared to return to full-duty work without restrictions. Maximum Medical Improvement (MMI) was assigned at week twenty-four, with a permanent impairment rating of 2%.

One temporary challenge arose when physical therapy authorization was delayed. This issue was resolved promptly through direct coordination with the claims team and did not impact the long-term outcome. Mild post-operative swelling occurred during the transition to weight-bearing, but it was managed effectively and did not interfere with progress.

Dr. Medina worked closely with the assigned case manager and the patient’s physical therapist throughout the recovery.

Regular updates and documentation ensured that all milestones and authorizations were aligned with the patient’s functional goals and return-to-work timeline.

This case demonstrates the value of early surgical intervention, coordinated care, and patient compliance. Under Dr. Medina’s direction, a complex injury was managed with precision, allowing the patient to recover full function and safely return to work within five months.

CASE OUTCOME

This case reflects the positive impact of early surgical intervention, proactive care coordination, and patient compliance. Through timely evaluation, surgical precision, and consistent follow-up, Dr. Marisel Medina guided the patient through a structured recovery plan that supported both healing and functional progress. Collaboration with the case manager and physical therapy team ensured that authorizations, documentation, and care milestones remained aligned. As a result, the patient achieved a safe and timely return to full-duty work within five months. This case serves as a strong example of how coordinated care and communication can lead to successful return-to-work outcomes, even after a complex injury.

Disclaimer: Each case is unique. Recovery timelines and outcomes vary depending on multiple factors, including injury severity, job demands, treatment compliance, and authorization processes. This case is shared as one example of a successful return-to-work outcome.

OMDOCS.COM

Dr. Marisel Medina, DPM

Board-Certified Podiatrist, Orthopaedic Center of South Florida

To schedule a new patient, contact the OCSF Workers’ Compensation team at workcomp@ocsfdocs.com or call 954.473.6344. Visit OCSFDOCS.COM for more information.