ANKLE FRACTURE

An ankle fracture is a break of any of the bones of the ankle joint. Its causes include a blow to the ankle, a fall landing on the feet, or most commonly, a twisting injury to the ankle. A physical examination and an x-ray will diagnose the injury. Most of the time an ankle fracture will heal, but it is possible to have some long-term pain and disability depending on the circumstances of the injury.

The symptoms of an ankle fracture are pain in the ankle, particularly when bearing weight or moving the ankle. The signs include swelling, bruising, and possibly deformity of the joint. Depending on the severity, an ankle fracture may not be more than a severe sprain in which the ligament has pulled its attachment off the bone. On the other hand, a fracture can result in a major disruption of the joint. This may include a dislocation of the ankle.

Treatment will depend on the severity and location of the fracture. It can range from treatment similar to a sprain with rest, ice, compression, and bracing for protected mobility, to surgery with placement of screws and plates to hold the bones together while they heal. A cast or a removable splint that will hold the bones in a stable position until they heal is the most common treatment. This will take 4 to 6 weeks in most cases. If a cast is used, there will be some weakness of the lower leg muscles after removal. This is probably the most common side effect and will resolve with physical therapy. Potential complications include failure of the fracture to heal (called a nonunion). Other complications include restriction of blood flow to the foot or toes if the cast is too tight or if there is swelling in the cast. Infection or bleeding related to surgery can also occur.

• You should take medications for pain control as prescribed. A diet containing adequate supplies of calcium will help with bone healing. You should keep your foot elevated for the first few days to minimize swelling. You may have crutches to use for walking. You should apply cold to your ankle the first day or so to minimize swelling. You will probably not receive any exercises to do until removal of the cast. Following those exercises or participating in physical therapy will shorten your recovery.

• You should minimize swelling in your ankle. You should avoid spending too much time on your feet or with your foot hanging down, since this will increase swelling. You should not place heat on the ankle for the same reason. Swelling may result in restriction of circulation to the foot. You should not get a plaster cast wet; even a fiberglass cast takes a long time to dry if it gets wet, so you should try to keep it dry. You should not stick objects such as coat hangers, pencils, or knitting needles down the cast to scratch itching places. If you break the skin, you may get an infection. Although a cast is designed to protect the ankle, it is not indestructible. You should try to avoid damaging the cast because that will make it less effective. Do not remove your cast too soon. This may result in reinjury that will significantly prolong the time to recovery. Do not remove your plastic or metal splint unless instructed to. It cannot keep your bones in position for healing unless it is in place.

• You should call your doctor if you notice any numbness, tingling, coldness, or duskiness of your toes. This could indicate that the cast is too tight or that there has been swelling of the ankle, resulting in restriction of circulation to your foot. You should call if you have damaged your splint or cast so that it is loose, or is allowing your ankle to move more than it should. If you had surgery, you need to call if fever develops, or if redness, swelling, or pus are present at the incision; these signs suggest that an infection is present. You should contact your doctor if you have increasing pain or are unable to use your ankle at some time after surgery, because this could be an indication that plates or screws have broken or shifted.

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