Usually an ankle fracture or ankle fracture results from accidents during sports or leisure. Often jumping or running causes this type of injury. The ankle is often bent over or twisted.

What is an ankle fracture?

Schematic representation of the anatomy and structure of the ankle. Click to enlarge.

An ankle fracture or ankle fracture is a fracture of the ankle joint on the upper ankle on the lower leg. The most common is a fracture of the fibula. In an ankle fracture, there may be different combinations of external or internal ankle and ligament injuries.

Ankle fractures are divided into three categories. A Weber A fracture occurs when the fracture is below the syndesmosis. Syndesmosis is a flat connective tissue that connects the articular bones to stabilize the joint. In a Weber A fracture, the syndesmosis is not injured, so the ankle fork is still stable.

A Weber B fracture is located at the level of 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 ruptured. In addition to these main types of ankle fracture, there may be various other forms that differ by the different location of the bone fracture and the injuries to the surrounding tissue or ligaments. Before treatment, a precise diagnosis of the ankle fracture is always required.

causes

An ankle fracture can be attributed to an accident in almost all cases. Most accidents happen during sports or other recreational activities. In some cases, alcohol is the cause of the accident. An ankle fracture can occur by folding over the ankle. This usually happens by slipping or stumbling.

Even a so-called turn-down can lead to an ankle fracture. A turnaround is a common skiing accident. In addition, ankle fractures can also be caused by traffic accidents or direct force on the ankle. Rarely are coordination disorders or a disturbed perception regarding one's own body movements the cause of an ankle fracture.

Symptoms, complaints & signs

An ankle fracture manifests itself primarily in 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 capacity of the injured joint is usually greatly reduced immediately after the fracture.

In addition, occasionally emotional disorders and nerve pain occur. The most obvious feature is the sharp pain that occurs on the affected foot. The pain sets in immediately after the injury and persists for several days to weeks. With the healing of the fracture also the pain subsides.

Swelling and other accompanying symptoms disappear completely after just a few days. The reduced load bearing capacity may persist for a few weeks or even months, depending on the severity of the fracture and the therapeutic measures taken. Assuming a comprehensive physiotherapy, an ankle fracture can be cured within four to six weeks.

Competitive athletes often need several months to fully compensate for muscle wasting that occurs during the recovery period. Outwardly this deficiency of the apparently emaciated calf and foot muscles can be seen.

Diagnosis & History

When diagnosing an ankle fracture, it is essential to study the mobility, sensibility and blood flow of the foot and lower leg. Thus, in addition to the suspected bone fracture also lesions of the syndesmosis or the surrounding ligaments and soft tissues can be detected.

Also, possible damage to nerves or vessels are diagnosed. For a detailed examination of the fracture, an X-ray examination is carried out. X-rays reveal fracture lines and joint irregularities. Magnetic resonance imaging or computed tomography can be used to definitively clarify ligament tears or syndesmotic lesions suspected during physical examination.

With proper treatment, ankle fractures heal usually well and without complications. In most cases, the hock is fully healed and resilient again after the treatment is complete. Important is a physiotherapy following the medical therapy.

Most are already six to twelve weeks after no gypsum must be worn, most sports again possible. In ankle fractures requiring surgery, complications rarely occur. Also wound healing disorders occur only rarely. Wound healing disorders may in rare cases occur after an ankle fracture with severe soft tissue damage.

complications

A fracture of the ankle can cause different complications. These include, for example, pressure necrosis of the skin, which is due to the thin skin conditions, the malalignment of the bones and the emergence of a swelling. In some cases, surgical removal of a metal implant may be required. Particularly problematic are fracture fractures.

Thus, the skin often comes under strong tension in the area of ​​the ankle, so that a rapid coarse reduction must be carried out. If the ankle is loaded too soon after fracture, there is a risk that the osteosynthesis material will shift or even break. This leads to the fact that the fracture does not heal or a pseudarthrosis (false joint formation) occurs.

Often affected by this complication are older people who suffer from osteoporosis (bone loss). For this reason, patients usually receive special orthotic shoes. Other possible sequelae of the ankle fracture are restricted mobility, chronic pain, reduced strength, stiffness of the ankle, the development of osteoarthritis, damage to the nerves such as emotional or movement disorders, circulatory disorders due to vascular injuries and tendon damage.

In addition, complications may occur during surgical treatment of ankle fracture. These are usually thromboses (blood clots), embolisms, injuries to vessels or nerves as well as wound or joint infections, which are formed by 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 there is a suspicion of an ankle fracture, it must be operated in most cases. Afterwards, the foot must not be stressed for weeks. Going to the doctor is inevitable. It must be done immediately after the onset of the ankle fracture. In most cases, sufferers know that there is a fracture. The foot often twists after breaking and hurts considerably. It can swell considerably.

If someone is bent over or slipped, this sudden load often causes a fracture to the ankle. It is one of the most common fractures on the leg. Skiers are affected as often 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.

For open fractures, the emergency treatment must start immediately. The emergency physician takes care of the initial treatment before transport to the hospital. With closed torsion fractures there is often a multiply fractured bone. Again, call the ambulance. Rarely does it come to a simple and less conspicuous ankle fracture. It is only noticeable by a swelling. Again, the walk to the doctor should be timely, so there is no consequential damage to ligaments or tendons.

Treatment & Therapy

The first treatment of an ankle fracture should be made as early as possible at the scene of the accident. The foot should be brought back to its normal position by a longitudinal pull possible. This further avoids damage to nerves and vessels. The further treatment depends on the type of breakage. It may be a conservative treatment. This is a therapy without surgery.

In this case, a plaster cast is created. As a result, the break is quiet and can heal in peace. In the period during which the plaster cast must be worn, drugs to prevent thrombosis are usually necessary. After the treatment with a plaster cast and sometimes even during this period, a new X-ray examination is necessary to check the bone position and the healing success.

Conservative therapy is mostly used in Weber A-type ankle fractures. For complicated or open fractures, surgical treatment is required. The fractured ends of the bones are fixed with nails, plates or wires. In the case of ankle fractures of types Weber-A and Weber-B, a partial loading of the fracture is possible after the operation, and a cast is applied for further treatment.

In the case of Weber-C fractures, it is usually necessary to completely relieve the affected leg for several weeks. This means that patients have to stay in bed for several weeks in order for the ankle fracture to heal in peace.

prevention

An ankle fracture can be prevented only to a limited extent, because most of the breakage is due to an accident. At best it is possible to avoid particularly risky sports or at least to the extent possible to take precautionary measures. Joint protectors and footwear can in some cases prevent an ankle fracture.

If the ankle fracture is operated on, follow-up treatment will follow. If the soft tissue is aborted, mobilization can begin. One to two days after the surgical procedure, depending on the extent of the discomfort, a load on the crutches of the forearm can be performed, provided that the care is stable. On the other hand, if there is an unstable supply, 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 in an ankle fracture is mobilizing and straining the painless body region. The load is either complete 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 resilient in the first days after the operation, if it does not cause pain. After three to six months, the patient is normally allowed to pursue sports activities again.

Sometimes the metal implants used to provide the foot with surgery need to be removed. Thus, the screws and plates can sometimes have a negative effect due to the thin skin and fatty tissue layer. However, if there is no pain from the implants, their removal is not required.

If the patient wears a cast splint, their elevation is important. To prevent thrombosis, 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 must be ensured that the bone structure is not exposed to overloading or situations of excessive demands. Therefore, sequences of movements must be optimized and timely breaks should be taken as soon as existing energy reserves have been reduced. Wearing appropriate and healthy footwear should take place. High heels are to be avoided and the shoe size should match the size of the feet. Otherwise, there may be an increased risk of accidents or complications in a healing process.

In an ankle fracture, it is particularly important to relieve the affected physical area during the healing process. Movements are to be reduced to a minimum. Often immobilization of the injured joint is necessary.

As soon as the situation improves, a slow build-up of the muscles and the strain is necessary. Daily exercises help the body to improve its health. Normally, a collaboration with a physiotherapist takes place. This works out exercises according to the individual needs of the patient. Even outside the sessions, the training sessions can be carried out independently. Nevertheless, a close consultation with the therapist is recommended, so that complications or excessive stress are prevented. In the execution of sports activities protection means for stabilizing the joint, such as bandages to use. For particularly severe complaints, these can also be used in everyday life during locomotion.

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