The physician sees the classic picture of an external ankle fracture as follows:
- Hematoma discoloration (bruise)
- Function restriction (Funktio laesa)
Depending on the extent of the fracture and the accompanying injuries, the above-mentioned signs (symptoms) of an external ankle fracture occur in varying degrees and locations. On reaching the doctor, the injured foot is unable to bear weight. Any attempt to put weight on the foot is associated with pain.
The upper ankle joint is swollen and discoloured with haematomas due to the bleeding caused by the accident. Due to the swelling, mobility in the ankle joint is significantly reduced. Sometimes a bone rubbing (crepitations) can be provoked during the mobility test.
Together with a distinct ankle joint malposition and open fractures, crepitations are certain symptoms for the presence of an external ankle fracture. During the examination, the accompanying vessel and nerve injuries must never be forgotten in order to avoid consequential damage and, in case of doubt, to be able to differentiate between complications caused by the accident and those caused therapeutically (iatrogenic, e.g. by the following operation). In addition, the search for further injury consequences should always be carried out.
- Outer ligament injuries (frequent injury): If no bony injury consequences are found in the X-ray image, a torn outer ligament may be present. Three outer ligaments stabilize the ankle joint in the area of the outer ankle and prevent it from buckling. They are very often injured.
During the clinical examination, an injury can provoke an increased lateral opening of the ankle joint or an advancement of the ankle bone. Retained x-rays of the ankle joint, in which an increased lateral opening of the ankle joint and an ankle bone advancement can be examined under standardized conditions, are rarely performed anymore. Therapy Conservative therapy is almost always successful here.
A padded, ankle joint stabilizing aircast splint is prescribed for 6 weeks. As a rule, a stable scar is formed. If the ankle joint remains unstable with frequent twisting injuries, an outer ligament plastic can be performed at a later date.
- Isolated syndesmosis injuries (often overlooked injury): An intact syndesmosis is essential for undisturbed function of the ankle joint. Isolated syndesmosis ruptures or insufficiencies are possible, although rare. In most cases the syndesmosis is also injured in the context of an ankle fracture.
Syndesmosis of the ankle is the ligament connection between the tibia and fibula near the ankle. It is responsible for stabilizing the ankle bone. If the syndesmosis tears or partially loses its function due to overstretching/partial tearing, the ankle fork is unstable.
The result is a divergence of the tibia and fibula when the foot is loaded. Pain under stress and damage to the joint cartilage are the consequences. Dynamic X-ray examination under the image converter is suitable for diagnosing a syndesmosis injury.
A syndesmosis injury can also be diagnosed by computer tomography or MRI. Therapy Surgical therapy is necessary here. The ankle joint fork is temporarily (temporarily) stabilized by means of 2 set screws through the calves and tibia.
After 6 weeks, during which the leg must not be loaded, the set screws can be removed again. – Injuries to the hindfoot (rare): fractured ankle and heel bone fractures are based on a different injury mechanism. Therapy almost always operative.
- Injuries of the tarsal: (rarely) fractures or dislocations of the tarsal bones. Therapy almost always operative. – Injuries of the metatarsus: A common injury is a basic fracture of the 5th metatarsal bone.
Pain can be triggered especially at the outer edge of the foot. Therapy Surgical treatment for displaced fractures, conservative treatment in a plaster cast for 6 weeks for non-displaced fractures. – Maisonneuve fracture: Combination injury consisting of a bony or ligamentous structural injury at the level of the inner ankle and a fracture of the fibula close to the knee joint (fibula fracture) with complete rupture of the tibia and fibula connection (Membrana interossea). Therapy: always operative.