A distal ankle fracture can have a variety of injury patterns. If a distal fibula fracture is treated early and appropriately, no secondary damage usually remains.
What is a distal malleolus fracture?
A distal malleolus fracture is a bone fracture that occurs relatively frequently in humans. Most notably, distal fibula fracture often occurs as a sports injury. A distal ankle fracture is one of the so-called ankle fractures. In medicine, a distal fibula fracture is classified according to, among other things, the severity of the external ankle fracture and the extent of damage it causes to adjacent body structures (such as tears to ligaments). A distal fibula fracture often manifests as immediate pain accompanied by bruising and severe swelling. In most cases, an affected person is unable to bear weight on the affected foot immediately after a distal ankle fracture.
Causes
In the vast majority of cases, a lateral ankle fracture is caused by a twisting or dislocation (also known as luxation in medicine) of the ankle bone. In this case, the ankle bone in the ankle joint protrudes from the so-called ankle fork, which forms the joint. Only very rarely is a distal fibula fracture the result of direct force. As a sports injury, a distal fibula fracture occurs primarily in ball sports (such as tennis or soccer); here, frequent shorter sprints with subsequent stopping movements occur, which pose an increased risk for an athlete to roll over and suffer a lateral ankle fracture. In addition, traffic accidents are also among the situations in which a distal fibula fracture is relatively common in injured individuals. Other factors that can limit walking safety and thus promote a distal fibula fracture include excessive consumption of alcohol or walking on slippery and/or uneven surfaces.
Symptoms, complaints, and signs
An external ankle fracture is primarily associated with very severe pain. The pain itself often spreads to the neighboring regions on the body, so that there is also severe pain and generally limited movement. The patient’s quality of life is greatly reduced by this hernia. In some cases, the affected person also briefly loses consciousness during the fracture and may possibly injure himself in a fall. Furthermore, the affected region swells and is usually also affected by a [[bruise9]]. The pain itself is stabbing and burning and can also lead to psychological limitations or irritability. Many patients suffer from depression as a result of the external ankle fracture. Due to the severe pain, running, walking or standing is no longer possible without further ado. Even the foot itself can no longer be put on. In most cases, however, an external ankle fracture can be treated well. Only in a few cases, and especially in severe cases, does this result in damage to the joint, so that it must be operated on. The pain itself usually disappears a few days after the fracture, if the region is plastered and treated properly.
Diagnosis and course
An external malleolar fracture is usually diagnosed with the help of X-rays. This diagnostic procedure allows, among other things, to show the anatomical course that a distal fibula fracture has; this is made possible by comparing two X-rays taken from different perspectives in the case of a distal ankle fracture. Often, such a standardized X-ray examination is sufficient to diagnose a fracture of the lateral malleolus; if structures such as joint capsules or ligaments that have been affected by a fracture of the lateral malleolus are also to be examined as part of the diagnosis, this is possible, for example, with the aid of magnetic resonance imaging (MRI) or computed tomography (CT). The course of a distal fibula fracture initially depends, for example, on the severity of the injury; if there are no complications during healing, possible residual symptoms such as sensitivity to the weather or swelling usually disappear completely after a few months. A complicated external ankle fracture can result in long-term joint damage; permanent complaints, such as chronic pain, are very rare.
Complications
In most cases, external ankle fractures do not result in further complications if the symptom is treated properly and, most importantly, early by a physician. With an external ankle fracture, the patient suffers from extremely severe pain, which in the worst case can lead to fainting. The ankle is swollen and reddened. It is usually not possible for the affected person to perform physical activities at the affected site. In most cases, the treatment is carried out with the help of a surgical intervention. This does not cause any further discomfort. The ankle is straightened and finally positioned in a cast so that it cannot move. Pain can be treated with the help of painkillers, but this subsides a few days after the fracture. Slight complications can occur if the fracture of the lateral malleolus was caused by an accident in which surrounding body parts and skin were also damaged. In this case, inflammation or infection may develop. Healing usually takes six weeks. During this time, the patient is severely limited in his or her movement and may be dependent on the help of other people or caregivers.
Treatment and therapy
Appropriate treatment steps after an external ankle fracture depend on the type and severity of the fracture. As first aid measures for a fracture of the lateral malleolus, in most cases medical professionals initially recommend taking pressure off the leg in question, elevating it and cooling it. If the fracture is a mild external ankle fracture in which the bone is not or hardly displaced, treatment can usually be conservative (i.e. without the use of surgical measures): For this purpose, in the case of a lateral ankle fracture, the ankle is first straightened and then immobilized for a certain period of time. Surgical intervention may be necessary after an external ankle fracture, for example, if the ends of the fracture have shifted considerably. Surgery may also be necessary if a distal fibula fracture is in the form of an open fracture or if vessels and/or nerves are affected. In this case, a distal ankle fracture is straightened and fixed with screws or plates. This procedure for a lateral ankle fracture is usually followed by a plaster cast that remains on the leg for about 6 weeks. Physiotherapy procedures can eventually have a positive effect on the healing process after a lateral ankle fracture.
Outlook and prognosis
Normally, the prognosis of an external ankle fracture can be considered good with prompt and optimal medical care. With initial treatment and then comprehensive examination, many complications can be avoided. The younger the patient is and the less damage to the ankle or ankle has been acquired in the past, the faster the recovery. In the healing process, the doctor’s advice should be taken into account so that too early reloading does not cause a relapse. Recovery takes several months and is prolonged as soon as the bones are overstressed too early or if the foot is not adequately rested. In case of complicated or multiple fractures of the ankle, surgical intervention takes place. Existing chipping is removed, corrections are initiated and stabilization of the ankle is performed. In principle, healing takes place even in the case of a severe injury. However, this takes more time and it cannot be guaranteed that the patient will be free of symptoms afterwards. In some cases, a restructuring of everyday life must take place and professional or recreational activities must be adapted to the conditions. Adverse effects are to be expected when wearing unhealthy footwear. The load-bearing capabilities of the lateral malleolus change after a fracture. Without medical attention, the patient risks painful adhesions to the ankle.
Prevention
Prevention of a distal ankle fracture can be achieved, for example, by wearing appropriate footwear; for example, when hiking on uneven terrain, shoes with a high shank can reduce the risk of suffering a distal fibula fracture. At the same time, exercising reflex and coordination can also prevent a distal ankle fracture.
Aftercare
Aftercare for a distal fibula fracture essentially consists of restoring all functions as well as monitoring tissue healing. For example, after surgery for an external malleolus fracture, the focus is on monitoring bone healing.This also involves checking whether or not any parts that may have been inserted (screws, plates) are causing problems. Since swelling and infections may occasionally occur, this is necessary. If necessary, the operation has to be performed again by other means. Checking of healing is done according to established protocols, depending on the therapy chosen. Follow-up examinations of the foot and tibia become unnecessary only when the patient can put normal weight on his foot again and the fracture has really healed. There is usually a final follow-up examination after one year. Another typical follow-up examination during the course of aftercare is, for example, the taking of an X-ray after six weeks. In addition, compression stockings (if needed) are prescribed at this time to help contain swelling. Part of the aftercare is a subsequent mixture of rest and exercise therapy. For example, walking should be done with supports for the time being; jumps and sprints should be avoided. At the same time, exercises (performed by a physiotherapist if necessary) should be used to restore the mobility of the foot. Restoration of athletic abilities can begin approximately from the third to sixth month after surgery. The exact schedule for such exercise therapies depends on the complexity of the external ankle fracture as well as its healing.
What you can do yourself
Anyone suffering from a painful external ankle fracture should follow the first aid measures and seek medical attention immediately. After or in addition to medical treatment, there are some self-help options to relieve swelling in the foot and speed up the recovery process. To minimize the pain and swelling, ice is often used to provide a comfortable cooling sensation. The ice has a vasoconstrictor effect on the injured tissue and therefore a positive effect on the associated redness, inflammation, heat and swelling. Cooling can take different forms, such as an ice pack in an ice bag or an ice spray. A quick aid is also an ordinary towel, which is placed damp in a plastic bag in the icebox as preparation. After about 15 minutes, the towel can be placed on the injured areas of the foot to provide relief from symptoms. It is also important to immobilize the joint and avoid overuse. In the period following an external ankle fracture, stress such as running, cycling or swimming should be avoided. Elevating the feet can counteract swelling and bruising. Although these self-help options can help with daily living and reduce pain, an external ankle fracture should always be under medical supervision.
