ANKLE-BONE FRACTURE |
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General Information
DEFINITION--A fracture, usually in either side of the ankle, often including a total tear of one or more ankle ligaments. A temporary dis-
location of the ankle joint may also occur. Ankle sprains are among the most common injuries in sports.
BODY PARTS INVOLVED
Lowest part of the lower leg bones (tibia and fibula).
Ligaments on either side of the ankle that support the ankle joint.
Three main bones of the ankle joint (talus, tibia, and fibula) may be involved with the dislocation or sprain.
Blood vessels, nerves, periosteum (covering of bone), and other soft tissue close to the injury site.
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SIGNS & SYMPTOMS
Severe ankle pain immediately after injury.
Popping or feeling of tearing in the outer or inner part of the ankle. Sometimes there will be a sensation that the ankle joint is dislocated or has popped back into joint.
Severe tenderness at the injury site.
The injured person usually falls at the time of injury and has difficulty walking.
Forcing the ankle in the direction of pain may reveal some looseness in the joint.
General swelling throughout the ankle and foot.
Bruising immediately or soon after injury.
CAUSESStress imposed from either side of the ankle joint that temporarily forces or pries the ankle or heel bone (talus) out of its normal socket. The ligament or ligaments that normally hold the joint in place are stretched and torn.
RISK INCREASES WITH
Previous ankle injury.
Contact sports.
Runners, walkers and those who jump in such sports as basketball, soccer, volleyball, skiing or distance and high-jumping. These persons often accidentally land on the side of the foot.
Shoes with inadequate support to prevent lateral displacement when stress occurs.
Poor nutrition, especially calcium deficiency.
Poor muscle strength or conditioning.
Inadequate strapping prior to participation in contact sports.
Walking or running on rough surfaces, such as roads with potholes.
HOW TO PREVENT
Engage in vigorous presport strengthening and conditioning.
Wear high-top athletic shoes for contact sports.
Have adequate taping (midfoot to midcalf) before participation in activities at risk.
Wear supportive elastic ankle wraps (not as good as tape, but better than nothing).
Support the ankle well during sports activities for 12 months after any significant ankle injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Hospitalization for surgery to pin broken bones together and to repair ruptured tendons.
Doctor's care.
Physical therapy after the cast is removed.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to assess total injury.
POSSIBLE COMPLICATIONS
Full extent of the injury may not be recognized immediately, delaying treatment.
Excessive postoperative bleeding or infection.
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated ankle injury.
Unstable or permanently arthritic ankle joint, if many repeat injuries occur.
PROBABLE OUTCOME
After surgery, ankle fracture-sprains require an average of 18 to 20 weeks to heal completely. The pins or screws inserted surgically to hold bones together are usually removed in 8 to 12 weeks. If this is a first-time injury, proper care, surgery and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments require as much healing time as fractured bones.
If non-surgical treatment is chosen, healing time while completely avoiding putting weight on the ankle may require 12 months.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Following surgery, the doctor may apply a stirrup boot splint from below the knee to the toes. Stirrup boots are less likely to cause problems with swelling than an immediate cast may cause. This will support the ankle effectively enough to walk on crutches, but you should not bear weight on the injured ankle.
When the swelling subsides several days later, sutures may be removed. The splint is replaced by a walking-boot cast for 10 to 21 days. See Appendix 2 (Care of Casts). Start walking on the walking cast immediately.
After the cast has been removed, strapping or a brace will be necessary for at least 6 weeks.
Bathe and shower as usual after the cast is removed, even if sutures are still in place.
After cast removal, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers or heating pads.
Take whirlpool treatments, if available.
Gentle massage will frequently provide
comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use aspirin, acetaminophen, or topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITYWalk with crutches until you have a walking cast. See Appendix 3 (Safe Use of Crutches). Resume your normal activities gradually. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of any severe ankle injury.
Pain, swelling or bruising increase during treatment or rehabilitation.
You notice numbness or discoloration of the toes when the walking cast is in place.
Signs of postoperative infection occur, such as fever, drainage from the surgical wound or increasing pain at the surgical site.
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