Conversation: The conversation between human and AI assistant.
[|Human|] I broke my ankle in Sep 2013. I had 2 screws and a device similar to a sling put in it. I began walking on it in Dec and had no pain until I started Cardiac rehab in Apr 2014. A recent xray says On the present examination metallic screws noted at the medial malleolus and the Union is incomplete at the medial malleolar fracture. Degenerative changes of right ankle noted with overlying soft tissue swelling . What can be done to help this ankle heal?
[|AI|]  If you have no pain in your ankle, I would leave things alone. If you have pain in your ankle, things are a bit complicated. Normally for a nonunion that the fracture fragments are in proximity, I'd use an electrical bone stimulator to help the fragments unite. If you have a pacemaker, the device would be a big mistake as it creates an electrical field which a pacemaker can misinterpret. Given the length of time since the fracture, there may not be enough bone activity/ blood flow across the fracture to have the stimulator work. An MRI or bone scan can help decide that. If there is no bone healing activity at the site, the screw would need to be removed, fracture sites curetted out to bring new blood flow, then reset with internal fixation. A bone graft may be needed at that time, and use of bone marrow aspirate or PRP injections may help assist the new union.