Ankle
> Ankle
Fractures
What are Ankle Fractures?
An ankle fracture is defined as a break of any of the
bones in the ankle. The most common fracture is to the
bony prominence on the outside of your ankle, called
the lateral malleolus. This bony prominence is the bottom
of your smaller lower leg bone, the fibula. The bony
prominence on the inside of your ankle, called the medial
malleolus, is less commonly fractured. Ankle fractures
fall into two categories: nondisplaced and displaced.
In nondisplaced fractures, there is a crack in the bone
but the joint retains its normal structure; your anklebone
(talus) remains between the shinbone (tibia) and the
smaller lower leg bone (fibula). In a displaced fracture,
fractured anklebones are severely displaced and the
ankle joint is dislocated. Fortunately, most ankle fractures
occur without a dislocation.
The usual cause of an ankle fracture
in an athlete is an unexpected change in the way the
foot makes contact with ground or floor. When you step
on someone’s foot, or on an object, or on an uneven
place on the turf or floor, your foot can tilt. Before
you have time to react, your ankle can severely twist
out of position and the bones can crack. Poor muscle
strength can also contribute to ankle fractures. The
peroneal muscles that run along the outside of your
lower leg and cross the ankle, are responsible for bringing
your ankle out to the side, which prevents your ankle
from inverting or turning inward. People who lack proper
peroneal muscle strength may have an inability to respond
to the environment or to keep the foot and leg in an
appropriate position when an unexpected twist occurs.
Considerations
If left untreated, an ankle fracture can be dangerous
to the stability of your ankle. The bones can move further
out of position, and the pain can intensify and hinder
your movement. For less severe fractures when the bones
have not moved out of position and your ankle is not
dislocated, a cast is the common method of care. Fractures
are treated in a cast when you are not at risk of later
instability. The most common type of ankle fracture
treated in a cast is a fracture to your smaller lower
bone (fibula) that is not associated with other fractures
or an ankle dislocation. You may be a candidate for
surgery depending on how far displaced your bones are
because of the fracture. Fractures in the bony knobs
on the sides of your ankles, called the medial and lateral
malleolus, often need to be fixed back into position
with screws or pins. The more severe the ankle fracture,
the more likely you are to need surgical treatment.
Orthopedic Evaluation |
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Though many people with mild or moderate
ankle pain may believe they can treat themselves at
home, you should have your ankle evaluated by a physician,
who can check for complications and decide on a specific
treatment program for your ankle. There usually are
three parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor may
order.
MEDICAL HISTORY
Your physician likely will ask about your activities,
which may have caused your ankle fracture. You will
probably be asked when the soreness or pain began. If
you have had any prior ankle injuries, your physician
will ask about the treatments you have tried in the
past. You should reveal any relevant ankle surgery history
at this time. Physicians generally suspect a less severe
fracture when patients have a history of swelling and
pain in their ankles that affects them during activity
and has not improved despite previous treatment. Severe
ankle fractures, on the other hand, usually can be diagnosed
immediately after the injury. Physicians also typically
ask about other conditions, such as diabetes and allergies,
and medications currently being taken. You may also
be asked about your physical and athletic goals –
information that will help decide what treatment might
be best for you in achieving those goals.
During the physical exam, a
physician typically looks for swelling and tenderness
when your ankle bones are pressed upon. Physicians usually
use their fingers to press areas all around your ankle
to see if there are any tender spots or bumps in the
bones. Your ankle may be moved up, down, side-to-side,
and rotated to see if any positions are more painful.
TESTS
X-rays usually are ordered first to see whether your
anklebones have been fractured. X-rays can show cracks
in the bones and bone chips on the bone surface. MRI
(magnetic resonance imaging) tests may be needed to
create images of your cartilage and any associated soft
tissue damage to ligaments or tendons. CT (computerized
tomography) tests may be needed to get a clear picture
of your bone structure. These pictures may reveal fractures
missed by X-rays.
RELATED TOPICS
Imaging
techniques
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