Ankle fractures
"I broke my ankle." A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are separated into pieces. There may be ligaments damaged as well.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you don’t put weight on it for three months.
Causes
• "Twisting" or rotating your ankle
• "Rolled" your ankle
• Tripping or falling
• Impact during a car accident.
Broken ankles affect all ages. Ankle fractures occur in 184 per 100,000 persons per year. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active and older population.
Symptoms
Because a severe ankle sprain can feel the same as a broken ankle, a physician should evaluate every ankle injury.
Common complaints for a broken ankle include:
• Immediate and severe pain
• Swelling
• Bruising
• Tender to touch
• Cannot put any weight on the injured foot
Deformity ("out of place"), particularly if the ankle joint is dislocated as well
Diagnosis
Besides a physical exam, X-rays are the most common way to evaluate an injured ankle. X-rays may be taken of the leg, ankle, and foot to make sure nothing else is injured.
Depending on the type of ankle fracture, the doctor may put pressure on the ankle and take a special X-ray, called a "stress test." This X-ray is done to see if certain ankle fractures require surgery.
Sometimes, a computed tomography (CT, or CAT) scan is done to further evaluate ankle injuries.
For some ankle fractures, magnetic resonance imaging (MRI) may be done to evaluate the ankle ligaments.
Non-surgical treatment
If the fracture is not out of place or just barely out of place and the ankle is stable, you may not need surgery. Some physicians let patients put weight on their leg right away, while others have them wait for six weeks.
Several different methods are used for protecting the fracture, ranging from a high-top tennis shoe to a short leg cast. Treatment may also be based on where the bone is broken.
A "stress" X-ray may be done to see if the ankle is stable. You will have to see your physician regularly to repeat your ankle X-rays to make sure the fragments of your fracture have not moved out of alignment during the healing process.
Surgical treatment
If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. To make your ankle stable, a plate and screws on the side of the bone or a screw or rod inside the bone may be used to re-align the bone fragments and keep them together as they heal.
Outcome
It takes at least six weeks for the broken bones to heal. It may take longer for the involved ligaments and tendons to heal.
While the bones are healing, your physician will probably schedule additional X-rays to see whether the bones are healing and to make sure that there is no movement of the bones. This is typically done more often during the first six weeks if surgery is not chosen.
Although most people return to normal daily activities, except for sports, within three to four months, studies have shown that people can still be recovering up to two years after their ankle fractures. It may take several months for you to stop limping while you walk, and before you can return to sports at your previous competitive level. Most people return to driving within nine to twelve weeks from the time they were injured.
Rehabilitation
Rehabilitation is very important regardless of how an ankle fracture is treated.
When your physician allows you to start moving your ankle, physical therapy and home exercise programmes are very important. Doing your exercises regularly is key.
Eventually, you will also start doing strengthening exercises. It may take several months for the muscles around your ankle to get strong enough for you to walk without a limp and to return to your regular activities.
Again, exercises only make a difference if you actually do them.
Weight bearing
Your specific fracture determines when you can start putting weight on your ankle. Your physician will allow you to start putting weight on your ankle when he or she feels your injury is stable enough to do so.
It is very important not to put weight on your ankle until your physician says you can. If you put weight on the injured ankle too early, the fracture fragments may move or your surgery may fail and you may have to start over.
Supports
It is very common to have several different kinds of things to wear on the injured ankle, depending on the injury.
Initially, most ankle fractures are placed in a splint to protect your ankle and allow for the swelling to go down. After that, you may be put into a cast or removable brace.
Even after the fracture has healed, your physician may recommend wearing an ankle brace for several months while you are doing sporting activities.
Complications
People who smoke, have diabetes, or are elderly are at a higher risk for complications after surgery, including problems with wound healing. This is because it may take longer for their bones to heal.
What to discuss with your orthopaedic surgeon:
• When will I be able to start putting weight on my leg?
• How long will I be off work?
• Do I have any specific risks for not doing well?
• If I have to have surgery, what are the risks?
• Do I have weak bone?
