ANKLE FRACTURE, BIMALLEOLAR |
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General Information
DEFINITION--A break in the bones of both sides of the ankle. A temporary dislocation and rupture of ligaments of the ankle joint may also accompany this injury. The fracture sites include both of the mallet-shaped sides of the lower end of the tibia (leg bone) and the corresponding side of the fibula (leg bone). The full extent of injury may not be recognized immediately.
BODY PARTS INVOLVED
Three main bones of the ankle joint--the talus, tibia and fibula.
Ligaments that support the ankle joint.
Blood vessels, nerves, periosteum (covering of bone), and other soft tissue close to the injury site.
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SIGNS & SYMPTOMS
Severe, immediate ankle pain.
A feeling of popping or tearing in the outer or inner part of the ankle. Sometimes it will feel as if the ankle joint was temporarily dislocated and popped back into joint. A sound may be heard at the time of fracture.
Severe tenderness at the injury site.
The injured person usually falls at the time of injury and has great difficulty walking.
General swelling and bruising immediately throughout the ankle and foot.
CAUSESDirect blow or stress imposed from either side of the ankle joint. The ligament or ligaments that normally hold the joint in place are stretched and sometimes torn.
RISK INCREASES WITH
Sports that demand quick changes in direction, such as football and skiing.
Activities involving jumping, such as basketball, soccer, volleyball, distance-jumping and high-jumping. Participants often accidentally land on the side of the foot or someone else lands on their foot.
Walking or running on rough surfaces, such as roads with potholes.
Shoes with inadequate support to prevent the foot from rolling over when stress occurs.
Poor nutrition.
Poor muscle strength or conditioning.
Inadequate strapping prior to contact or collision sports.
Previous ankle injury.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape the ankle from midfoot to midcalf before practice or competition. If you cannot use tape, wrap the ankle with elastic bandages.
Wear proper protective shoes.
Provide the ankle with substantial support during sports activities for 12 months following any significant ankle injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Surgery to pin broken bones.
Doctor's care.
Physical therapy after the cast is removed.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to assess total injury. Fractures of the ankle bones are often associated with torn ligaments (sprains).
POSSIBLE COMPLICATIONS
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. Arthritic changes may also occur in the knee joint because the ankle fracture sometimes causes added stress on the knee due to changes in weight-bearing.
PROBABLE OUTCOMEAnkle fractures require an average of 18 to 20 weeks to heal completely. Surgical pins or screws 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. If non-surgical treatment is chosen, healing time and inability to bear weight 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 physician 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 in several days, sutures are usually removed and the splint is replaced by a walking-boot cast. This cast may need to stay in place for 10 to 21 days. You may walk on the walking cast immediately.
After the cast is removed, strapping will be necessary for a minimum of 6 weeks.
Bathe and shower as usual after the cast is removed, even if sutures are still in place.
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured ankle. Use for 20 minutes at a time.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Massage the ankle gently and often to provide comfort and decrease swelling.
MEDICATIONS
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 surgeon applies the walking cast. See Appendix 3 (Safe Use of Crutches). Resume your normal activities gradually, but don't drive until healing is complete.
DIETDuring 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.
REHABILITATION
Begin daily rehabilitation exercises when movement is comfortable.
Use ice massage for 10 minutes before and 10 minutes after exercise. 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.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have 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.
You develop signs of postoperative infection (fever or increasing pain or drainage from the surgical wound).
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