Advertisement

Ankle fractures (broken ankle)

I have sometime in the past written about ankle injuries but events from this past week make it imperative that I revisit this topic. We all watched with horror Jerry Akaminko break his ankle in a warm- up game between Ghana and Holland.

He sustained the injury when he landed awkwardly from a jump and twisted his ankle, resulting in a fracture. I have found it interesting listening to all the opinions out there about his injury. 

The fact is that ankle fractures are very common in all sporting disciplines. Generally speaking, injuries to the ankle are more common than injuries to the knee joint. This is because the ankle is the lowest major joint that supports the body weight and also the smallest compared to the knee and the hip. 

Anatomy

Three bones make up the ankle joint.

Tibia: which is the shinbone.

Fibula: the smaller bone of the leg.

Talus: a small bone that sits between the heel bone (calcaneus) and the tibia and fibula.

Mechanism of injury

Ankle fractures can occur either from contact or non-contact. Most of the fractures are from non-contact events where the athlete twists, rolls or trips and falls. Less frequently, it occurs from contact from another player.

As illustrated in the picture, as the athlete looses balance either from landing, a jump or tripping, the ankle is rolled out with a twisting movement and the body weight is then exerted on to the abnormally positioned ankle. This force is too much for the bones of the ankle to contain and ends up breaking.

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which force your ankle out of place and may require that you do not put weight on it for a few months.

Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.

Symptoms 

Common symptoms 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

First Aid Treatment

Once you suspect that the ankle is broken, it should be splinted. The splint prevents the broken bones from further moving out of position so as not to cause more damage to the surrounding skin and other vital structures. 

The ankle is then elevated by placing it on two pillows. This prevents further swelling and allows the initial swelling to reduce to normal.Ice packs can also be applied to reduce swelling.

Hospital care

An x-ray is mandatory to confirm the presence of a fracture and also identify the complexity of the injury. Where ligaments and cartilage of the ankle joint are suspected to be involved, then a CT (Computerised Axial Tomography) or an MRI (Magnetic Resonance Imaging) scan is required to further detail the injury.

From reports from the camp, Jerry’s injury will be similar to this x-ray.

Treatment of ankle fractures

Not all ankle fractures require surgery. In those cases where a single bone is broken but has not moved out of place, surgery may not be required. It can be treated in a plaster of Paris (POP) cast for six weeks. However, regular x-rays should be obtained to make sure the broken bone is still in place and has not moved out.

Surgery is offered when the broken piece of bone has moved out of place or when there is more than one piece of bone involved. This is because the ankle joint then becomes unstable and treatment with a POP cast will lead to poor results and a lot of complications.

Surgery involves putting back the pieces of bones into normal position and holding them together with a plate and screws.

After surgery, the athlete is advised not to walk on the involved leg and uses a pair of crutches to get around for up to 6 weeks after which he can start putting some weight on the injured ankle and start rehabilitation to improve the condition of the ankle. Typically by 3 months he will be able to walk on the ankle without any pain and discomfort. The plates and screws are removed after 9-12 months.

Ankle fractures are season-ending injuries, meaning you are out for a whole season if you fracture your ankle. It takes an average of 9 months to return to play.

The outlook for an athlete with an ankle fracture is good. About 95 per cent of them are able to return to their pre-injury level of play. 

Connect With Us : 0242202447 | 0551484843 | 0266361755 | 059 199 7513 |