ANKLE FRACTURE, CHONDRAL |
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General Information
DEFINITION--A fracture of the ankle involving both bone and cartilage, accompanied by a total tear (or sprain) of one or more ligaments. A temporary dislocation of the ankle joint may also occur. Two-ligament sprains with a chondral fracture of the ankle will cause more disability than a single-ligament sprain.
BODY PARTS INVOLVED
Bones and cartilage of the foot and heel.
Ligaments that support the ankle joint.
Weight-bearing surfaces of the ankle.
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SIGNS & SYMPTOMS
Severe pain in the ankle appearing at the time of the injury.
Popping or a 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 was temporarily dislocated and popped back into joint.
Severe tenderness at the injury site.
Loss of function. The injured person usually falls at the time of injury and has great difficulty when attempting to walk. The ankle loses its stability.
Looseness in the joint if the foot is forced in the direction of pain.
Generalized swelling immediately throughout the ankle and foot.
Bruising immediately or soon after injury.
Continuing signs and symptoms with little improvement, indicating an injury more severe than a simple sprain.
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 ligaments that normally hold the joint in place are stretched and torn.
RISK INCREASES WITH
Previous ankle injury.
Activities in which the foot may land sideways, such as running, walking, and jumping in such sports as basketball, soccer, volleyball, skiing, distance and high jumping.
Shoes with inadequate support to prevent sideways displacement when stress occurs.
Poor nutrition, especially calcium deficiency.
Poor muscle strength or conditioning.
Inadequate ankle 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.
Tape ankle adequately (midfoot to midcalf) before participation in contact sports. Otherwise, wear supportive elastic ankle wraps (not as good as tape, but better than nothing).
Provide the ankle with substantial support during sports activities for 12 months following any significant ankle injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Hospitalization for surgery to insert metal pins or screws to hold broken bits of bone together and to repair the ruptured ligaments.
Doctor's care for application of a walking cast after surgery and ankle taping when the cast is no longer needed.
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. Chondral fractures of ankle bones are often associated with torn ligaments (sprains).
POSSIBLE COMPLICATIONS
Full extent of the injury is sometimes not recognized immediately, delaying treatment.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated ankle injury.
Unstable or arthritic ankle joint following repeated injury.
PROBABLE OUTCOMEHealing time after surgery averages 18 to 20 weeks. 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 (including surgery) and sufficient time for healing before resuming activity should prevent permanent disability. Torn ligaments require as much time to heal as fractured bones. If non-surgical treatment is chosen and no weight is put on the ankle, healing time may take up to 12 months.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
To prevent further injury to the ankle, avoid any weight-bearing. Go to your doctor's office or hospital emergency room as soon as possible.
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 a cast may cause. This will support the joint 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 and the splint will be replaced by a walking-boot cast. See Appendix 2 (Care of Casts). This cast may need to stay in place for 10 to 21 days. Start walking on the walking cast immediately.
After the cast has been removed, strapping will be necessary for a minimum of 6 weeks.
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, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Gentle, frequent massage will provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITYWalk with crutches until your doctor applies the 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 toes when the walking cast is in place.
Signs of postoperative infection occur, including fever, drainage from the surgical wound or increasing pain at the surgical site.
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