Ankle fracture

Usually one arises Ankle fracture or a Ankle fracture through accidents during sport or leisure. This type of injury is common when jumping or running. The ankle is often bent or twisted.

What is an ankle fracture?

At a Ankle fracture or at one Ankle fracture it is a fracture of the ankle joint fork on the upper ankle joint on the lower leg. The most common fracture is the fibula. An ankle fracture can have 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 break is below the syndesmosis. Syndesmosis is a flat connective tissue that connects the joint bones with one another and thus stabilizes the joint. With a Weber A fracture, the syndesmosis is not injured, so the ankle joint remains stable.

A Weber B fracture is at the level of the syndesmosis. As a result, it is often injured. In a Weber C fracture, the break point is above the syndesmosis, which is usually torn. In addition to these main types of ankle joint fracture, there can be various other forms, which differ in the different position of the bone fracture and the injuries to the surrounding tissue or ligaments. An accurate diagnosis of the ankle fracture is always required before treatment.

causes

A Ankle fracture can be traced back to an accident in almost all cases. Most of the time the accidents occur during sports or other leisure time activities. In some cases, alcohol is also the cause of the accident. An ankle fracture can occur when the ankle is twisted. Mostly this happens by slipping or tripping.

A so-called twisting fall can also lead to an ankle fracture. A twisting fall is a common skiing accident. In addition, ankle fractures can also result from traffic accidents or direct force on the ankle. Coordination disorders or a disturbed perception of one's own body movements are rarely the cause of an ankle fracture.

Symptoms, ailments & signs

An ankle fracture manifests itself primarily as severe, usually acute pain in the area of ​​the affected joint. Externally, the fracture can be recognized by the swelling in the joint area. Depending on the severity of the injury, bleeding and skin damage can also occur in varying degrees of severity. The load-bearing capacity of the injured joint is usually greatly reduced immediately after the fracture.

In addition, sensory disturbances and nerve pain occasionally occur. The most obvious feature is the sharp pain that occurs when stepping on the affected foot. The pain sets in 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 a few days. The reduced exercise capacity can sometimes persist for a few weeks or even months, depending on the severity of the fracture and the therapeutic measures taken. Provided extensive physiotherapy is provided, an ankle fracture can be healed within four to six weeks.

Competitive athletes often need several months to fully compensate for the muscle wasting that occurs during the rest phase. This deficiency can be seen externally in the apparently emaciated calf and foot muscles.

Diagnosis & course

When diagnosing a Ankle fracture An examination of the mobility, the sensitivity and the blood circulation of the foot and the lower leg is essential. In addition to the suspected bone fracture, injuries to the syndesmosis or the surrounding ligaments and soft tissues can also be detected.

Possible damage to nerves or vessels is also diagnosed in this way. An X-ray examination is carried out to examine the fracture precisely. With the help of the x-rays, fracture lines and joint irregularities can be identified. Magnetic resonance tomography or computed tomography can be used to finally clarify ligament tears or injuries of the syndesmosis suspected during the physical examination.

With professional treatment, ankle fractures usually heal well and without complications. In most cases, the ankle is completely healed and resilient again after the treatment is completed. Physiotherapy after medical therapy is important.

Most sports are usually possible again six to twelve weeks after you no longer have to wear a cast. Complications rarely occur with ankle fractures that require surgery. Wound healing disorders also rarely occur. In rare cases, wound healing disorders can occur after an ankle fracture with severe soft tissue damage.

Complications

An ankle fracture can cause a variety of complications. These include, for example, pressure necrosis of the skin, which is due to the thin skin, the misalignment of the bones and the development of swelling. In some cases, surgical removal of a metal implant may therefore be necessary. Dislocated fractures are particularly problematic.

The skin often comes under great tension in the area of ​​the inner ankle, so that a rapid gross dislocation has to be carried out. If the ankle is stressed too early after the fracture, there is a risk that the osteosynthesis material will shift or even break out. This means that the fracture does not heal or a pseudarthrosis (false joint formation) occurs.

Older people who suffer from osteoporosis (bone loss) are often affected by this complication. For this reason, patients are usually given special orthotic shoes. Other conceivable sequelae of ankle fracture are restricted mobility, chronic pain, reduced strength, stiffening of the ankle, the development of osteoarthritis, damage to the nerves such as sensory or movement disorders, circulatory disorders due to vascular injuries and impairment of the tendon.

In addition, complications can arise during surgical treatment of the ankle fracture. These are mostly thromboses (blood clots), embolisms, injuries to blood vessels or nerves as well as wound or joint infections that develop as a result of permanent movement restrictions. If there is a severe soft tissue injury in addition to the ankle fracture, there is a risk that wound healing will be delayed.

When should you go to the doctor?

If an ankle fracture is suspected, in most cases it will require surgery. Afterwards, the foot must not be weighted for weeks. Going to the doctor is inevitable. It must be performed immediately after the ankle fracture occurs. In most cases, people will know they have a fracture. The foot often twists and hurts significantly after the fracture. It can swell considerably.

If someone twisted or slipped, this sudden load often results in a twisting fracture in the ankle. It is one of the most common fractures in the leg. Skiers are just as often affected as other athletes who do a lot of footwork. Since the ankle area with the adjacent foot is essential for walking and standing, it is important to treat this break as quickly as possible.

Emergency treatment must start immediately in the case of open fractures. The emergency doctor takes care of the initial treatment before the transport to hospital. In the case of closed torsional fractures, the bone is often broken several times. The emergency doctor must also be called here. A simple and less noticeable ankle fracture occurs less often. It is only noticeable as a swelling. Here, too, you should see a doctor promptly so that there is no consequential damage to ligaments or tendons.

Treatment & Therapy

The first treatment one Ankle fracture should be done at the scene of the accident if possible. The foot should be brought back into its normal position by pulling it longitudinally. This further prevents damage to nerves and blood vessels. Further treatment depends on the type of break. Conservative treatment can be used. This is therapy without surgery.

A plaster cast is applied. This immobilizes the fracture point and allows it to heal in peace. During the time the cast has to be worn, medication is usually necessary to prevent thrombosis. After the treatment with a plaster cast and sometimes even during the treatment, another X-ray examination is 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 hernias. The broken ends of the bones are fixed with nails, plates or wires. In the case of ankle fractures of the types Weber-A and Weber-B, a partial load of the fracture is possible after the operation and a plaster cast is put on for further treatment.

For Weber-C fractures, it is usually necessary to fully relieve the affected leg for several weeks. This means that in this case the patient has to stay in bed for several weeks so that the ankle fracture can heal in peace.

prevention

One Ankle fracture can only be prevented to a limited extent, because the break is usually due to an accident. It is at best possible to avoid particularly high-risk sports or at least to take precautionary measures as far as possible. In some cases, joint protectors and appropriate footwear can prevent ankle fractures.

If the ankle fracture is operated on, follow-up treatment follows. If the soft tissues are swollen, mobilization can begin. Just one to two days after the surgical procedure, depending on the extent of the symptoms, a load on forearm crutches can be carried out, provided the supply is stable. If, on the other hand, the supply is unstable, only a partial load is possible. Depending on the quality of the bone, a lower leg cast or an orthosis can be used.

Aftercare

One of the most important follow-up measures for an ankle fracture is mobilizing and stressing the pain-free region of the body. The load takes place either completely or as a partial load of up to 15 kilograms. Normally, a full load can take place after four to six weeks. The foot is already resilient in the first few days after the operation if it does not cause pain. After three to six months, the patient is normally allowed to resume sporting activities.

Sometimes the metal implants that were surgically restored to the foot also have to be removed. The screws and plates can sometimes have a negative effect due to the thin layer of skin and fatty tissue. However, if the implants are not painful, they do not need to be removed.

If the patient is wearing a plaster splint, it is important to elevate it. So that no thrombosis forms, the patient receives appropriate medication in the form of pre-filled injections. These are injected once a day.

You can do that yourself

In everyday life it is important to ensure that the bone structure is not exposed to excessive loads or situations of excessive demands. Therefore, movement sequences must be optimized and timely breaks must 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 particularly important to relieve the affected body region during the healing process. Movement sequences are to be reduced to a minimum. It is often necessary to immobilize the injured joint.

As soon as there is an improvement in the situation, a slow build-up of muscles and loads is necessary. Daily exercises support the organism in improving health. Normally there is a collaboration with a physiotherapist. He works out exercises according to the individual needs of the patient. The training units can also be carried out independently outside of the meetings. However, close coordination with the therapist is advisable so that complications or excessive stress are prevented. When performing sporting activities, protective devices to stabilize the joint, such as Bandages to use. In the case of particularly severe complaints, these can also be used in everyday life when moving.