Most often, an ankle fracture or break occurs as a result of accidents during sports or recreation. Often, this type of injury occurs while jumping or running. In this case, the ankle is often bent or twisted.
What is an ankle fracture?
Schematic diagram showing the anatomy and structure of the ankle joint. Click to enlarge. An ankle fracture, or fracture of the ankle joint, is a fracture of the ankle fork at the upper ankle joint on the lower leg. The most common fracture is to the fibula. Ankle fractures can involve different combinations of injuries to the outer or inner ankle and ligaments. Ankle fractures are divided into three categories. A Weber A fracture is when the fracture is below the syndesmosis. The syndesmosis is a flat connective tissue that connects the joint bones together to stabilize the joint. In a Weber A fracture, the syndesmosis is not injured, so the ankle fork remains stable. A Weber B fracture is located at the level of the syndesmosis. As a result, this is often injured as well. In a Weber C fracture, the fracture site is above the syndesmosis, which is usually torn. In addition to these main types of ankle fracture, there can be various other forms against, which differ in the different location of the bone fracture and the injuries to the surrounding tissue or ligaments. An accurate diagnosis of the ankle fracture is always needed before treatment.
Causes
An ankle fracture can be attributed to an accident in almost all cases. Most often, the accidents occur during sports or other recreational time activities. In some cases, alcohol is also causally involved in the accident. An ankle fracture can occur when the ankle is twisted. Most often, this happens due to slipping or tripping. A so-called twisting fall can also lead to an ankle fracture. A spinning fall is a common accident while skiing. In addition, ankle fractures can also result from traffic accidents or exposure of the ankle to direct force. Rather rarely, coordination problems or impaired perception regarding one’s own body movements are the cause of an ankle fracture.
Symptoms, complaints, and signs
An ankle fracture is primarily manifested by severe, usually acute pain in the area of the affected joint. Externally, the fracture can be recognized by swelling in the joint area. Depending on the severity of the injury, bleeding and skin damage of varying degrees of severity may also occur. The load-bearing capacity of the injured joint is usually greatly reduced immediately after the fracture. In addition, sensory disturbances as well as nerve pain occasionally occur. The most obvious characteristic is the stabbing pain, which occurs when stepping on the affected foot. The pain presents itself immediately after the injury and persists for several days to weeks. As the fracture heals, the pain also subsides. Swelling and other accompanying symptoms subside completely after only a few days. Reduced weight-bearing capacity can sometimes persist for several weeks or even months, depending on the severity of the fracture and the therapeutic measures undertaken. Assuming comprehensive physiotherapy, an ankle fracture can be cured within four to six weeks. Competitive athletes often need several months to fully compensate for the muscle atrophy that occurs during the resting phase. Externally, this deficiency can be seen in the apparent emaciation of calf and foot muscles.
Diagnosis and course
When diagnosing an ankle fracture, an examination of the mobility, sensitivity, and circulation of the foot and on the lower leg is essential. In this way, injuries to the syndesmosis or surrounding ligaments and soft tissues can be detected in addition to the suspected fracture. Possible damage to nerves or vessels is also diagnosed in this way. An X-ray examination is performed to examine the fracture in detail. X-rays can be used to identify fracture lines and joint irregularities. Magnetic resonance imaging or computer tomography can be used to definitively clarify suspected torn ligaments or injuries to the syndesmosis during the physical examination.With proper treatment, ankle fractures usually heal well and without complications. In most cases, the ankle joint is completely healed and able to bear weight again after the treatment is completed. Physiotherapy following medical therapy is important. In most cases, most sports are possible again six to twelve weeks after a cast no longer has to be worn. Complications rarely occur with ankle fractures that require surgical intervention. Wound healing disorders also occur only rarely. Wound healing disorders can occur in rare cases after an ankle fracture with severe soft tissue damage.
Complications
AFracture of the ankle joint can cause various complications. These include, for example, pressure necrosis of the skin, which is due to the thin skin conditions, the misalignment of the bones, and the development of swelling. In some cases, surgical removal of a metal implant may be necessary because of this. Dislocation fractures are considered to be particularly problematic. For example, the skin often comes under severe tension in the area of the inner ankle, so that a rapid gross dislocation must be performed. If the ankle joint is loaded too soon after the fracture, there is a risk that the osteosynthesis material will shift or even break out. This leads to the fracture not healing or to pseudarthrosis (false joint formation). Older people suffering from osteoporosis (bone loss) are frequently affected by this complication. For this reason, patients usually receive special orthotic shoes. Other conceivable sequelae of ankle fracture include restricted movement, chronic pain, reduced strength, stiffening of the ankle joint, the development of osteoarthritis, damage to the nerves such as sensory or movement disorders, circulatory disorders due to vascular injury, and impairment of the tendon. In addition, complications can arise during the surgical therapies of the ankle fracture. These are usually thromboses (blood clots), embolisms, injuries to vessels or nerves, and wound or joint infections that develop due to permanent movement restrictions. If a severe soft tissue injury is present in addition to the ankle fracture, there is a risk that wound healing will be delayed.
When should you see a doctor?
If an ankle fracture is suspected, it will require surgery in most cases. Afterwards, the foot must not be loaded for weeks. Going to the doctor is unavoidable. It has to be done immediately after the occurrence of the ankle fracture. In most cases, the affected person knows that there is a fracture. The foot often twists after the fracture and hurts considerably. It may swell considerably. If someone has twisted or slipped, a twisting fracture of the ankle often occurs under this sudden stress. This is one of the most common fractures of the leg. Skiers are affected just as often as other athletes who do a lot of leg work. Since the ankle area with the adjacent foot is essential for walking and standing, it is important to treat this fracture as soon as possible. For open fractures, emergency treatment must begin immediately. The emergency physician will provide initial treatment before transport to the hospital. In closed twisting fractures, there is often a multiple fractured bone. Again, the emergency physician must be called. More rarely, there is a simple ankle fracture that is not very noticeable. It is only noticeable by swelling. Here, too, the visit to the doctor should be prompt, so that there is no subsequent damage to ligaments or tendons.
Treatment and therapy
The first treatment of an ankle fracture should be carried out at the scene of the accident, if possible. This should involve restoring the foot to its normal position by longitudinal traction if possible. This prevents further damage to nerves and vessels. Further treatment depends on the type of fracture. Conservative treatment can be given. This is a therapy without surgery. In this case, a plaster cast is applied. This immobilizes the fracture site and allows it to heal at rest. During the time that the plaster cast must be worn, medication is usually necessary to prevent thrombosis.After treatment with a plaster cast and sometimes even during this time, renewed X-ray examinations are necessary to check the bone positions and the healing success. Conservative therapy is mostly used for ankle fractures of the Weber A type. Surgical treatment is required for complicated or open fractures. In this case, the fracture ends of the bones are fixed with nails, plates or wires. In the case of Weber-A and Weber-B type ankle fractures, partial weight-bearing of the fracture is possible after surgery and a plaster cast is applied for further treatment. In the case of Weber-C type fractures, it is usually necessary to completely relieve the affected leg for several weeks. This means patients in this case must be on bed rest for several weeks to allow the ankle fracture to heal at rest.
Prevention
An ankle fracture can only be prevented to a limited extent, because the fracture usually occurs due to an accident. At best, it is possible to avoid particularly high-risk sports or at least to take precautionary measures as far as possible. For example, joint protectors and appropriate footwear can prevent an ankle fracture in some cases. If the ankle fracture is operated on, follow-up treatment follows. Once the soft tissues have swollen down, mobilization can begin. Depending on the extent of the symptoms, weight-bearing on crutches can be performed as early as one to two days after the surgical intervention, provided the fitting is stable. If, on the other hand, the fitting is unstable, only partial weight-bearing is possible. Depending on the quality of the bone, a lower leg cast or an orthosis may be used.
Aftercare
The most important aftercare measures for an ankle fracture include mobilization and weight-bearing in the pain-free region of the body. Weight-bearing is done either completely or as partial weight-bearing of up to 15 kilograms. Normally, full weight-bearing can take place after four to six weeks. The foot can already be loaded in the first few days after the operation if this does not cause pain. After three to six months, the patient is normally allowed to resume sporting activities. Sometimes the metal implants with which the foot was surgically treated have to be removed again. For example, the screws and plates can sometimes have a negative effect due to the thin layer of skin and fatty tissue. However, if there is no pain caused by the implants, their removal is not necessary. If the patient wears a plaster splint, its elevation is important. To prevent thrombosis from forming, the patient receives appropriate medication in the form of ready-to-use injections. These are injected once a day.
What you can do yourself
In everyday life, care should be taken to ensure that the bone structure is not subjected to overloads or situations of excessive strain. Therefore, movement sequences are to be optimized and timely breaks are to be taken as soon as existing energy reserves are depleted. Appropriate and healthy footwear should be worn. High heels should be avoided and the shoe size should correspond to the size of the feet. Otherwise, there may be an increased risk of accidents or complications in a healing process. In the case of an ankle fracture, it is especially important to take pressure off the affected physical region during the healing process. Movement patterns should be reduced to a minimum. Immobilization of the injured joint is often necessary. As soon as the situation improves, a slow build-up of muscles and loads is necessary. Daily exercises support the organism in improving health. Normally there is a cooperation with a physiotherapist. The latter develops exercises according to the individual needs of the patient. Outside the sessions, the training sessions can also be carried out independently. Nevertheless, close coordination with the therapist is advisable to prevent complications or excessive strain. When performing sports activities, protective devices to stabilize the joint, such as bandages, should be used. In cases of particularly severe discomfort, these can also be used in everyday life during locomotion.