INTRODUCTION

I am Dimple Parekh, if you are seeking solutions of your problems related to Ankle fracture, then this blog is for you. It contains all the information you need to know. Start your speedy recovery confidently. I am sharing few tips and important stuff I learned during my recovery phase.

Ankle fractures are very common injuries among people of all ages, interests and lifestyles. Athletes are more prone to such injuries because of the physical demand placed on their ankles. In order to know more about the ankle fracture related problems, and to prevent its complications, we must understand the anatomy of an ankle and what exactly the ankle fracture is.

ANKLE 

Ankle joint is made up of 3 bones. It is very complex joint.

Tibia - Shinbone, larger of the 2 bones of lower leg - bears 90% of your body weight.

Fibula - thinner bone of a lower leg - bears only 10% of your body weight.

And                               

Talus - a small bone that is placed between the heel bone and the ends of tibia and fibula. It is wedge shaped. It supports the lower ends of tibia and fibula and it forms a solid base of the normal range of ankle movements.

These ankle fractures are either stable (no change in talus movement) or unstable (talus does not move in a normal way). This means that the joint is not in a symmetrical position. In case of unstable fracture, more invasive treatment is advised.

Other parts of Ankle - Inside part of the tibia is called medial malleolus

                               - Back part of the tibia is called posterior malleolus

                               - End of the fibula is called lateral malleolus

WHAT IS ANKLE FRACTURE or BROKEN ANKLE ?

It means one or more bones of ankle joint are broken. If the end of fibula breaks, it is called Lateral malleolus #. When both, tibia and fibula break, it is called Bimalleolar #.And if all the 3 malleoli are broken then it is called Trimalleolar #.This fracture can be associated with dislocation.

If there is open fracture ( bones poking through skin ) , then there is severe risk of getting infection as this open wound will attract bacteria which will contaminate the broken bone. And I tell you THIS IS DANGEROUS.

There are 2 joints involved in an ankle fracture.

1. Ankle Joint - here tibia, fibula and talus meet.

2. Syndesmosis Joint - this is between tibia and fibula, held together by ligament. 

There can be damage to the ligaments which hold the ankle joint and bones in position.

If you have only one break in ankle, it does not prevent you from walking, but if it is more than one then definitely you require immobilization for few weeks.

CAUSES :  An ankle fracture can occur when the joint is forced beyond its normal range of motion. It can be caused by a direct blow to the bone itself.

Other causes include,

1. Twitching of ankle

2. Falls

3. A sporting accident or an impact during a car accident

4. Rolling of ankle

HOW YOU WILL FIND OUT YOUR ANKLE IS BROKEN ?

1. Tremendous throbbing pain immediately

2. Swelling

3. Significant Bruising

4. Tender to touch especially bone area around the ankle 

5. Difficulty in walking and inability to put weight on the injured foot

6. Dislocation may happen

7. Due to terrible pain and shock, you feel dizzy and you may faint.

8. A crack sound during injury ( in some cases )

9. Severe ankle deformity in case of open fracture.

WHAT YOU SHOULD DO ?

- Seek Help first

- Rush to the nearest, preferably orthopedic center, as soon as possible

- Do not put any kind of weight on the injured leg (it will give so much pain, you never had imagined)

- Apply ice pack if possible while going to the hospital. It will reduce your pain and    swelling.( do not apply ice directly).cold packs are effective for 24 - 48 hours.
-keep your leg elevated to help to decrease pain and swelling
-take ibuprofen tablet immediately.It reduces pain as well as inflammation.

- Call the ambulance if your fracture is open

PHYSICIANS ROLE

After taking your medical history carefully and examining you physically, he may advise for one or more additional tests to provide more information about the injury.

X -RAYS - confirms the fractures or any dislocation. It can also show if one or more bone pieces are broken. Stress fractures can be missed by x-rays until the break actually starts healing.

C.T.Scan (Computerized Tomography) - It is the cross section image of ankle, gives the minute information which can be missed on x-rays. It reveals all about the bones in detail and soft tissues surrounds it .This helps your doctor to ascertain the best treatment for you.

MRI (Magnetic Resonance Imaging) - This provides high resolution detailed images of both bones and soft tissues (like ligaments). This can identify fractures which are not seen on x-rays. Mostly used for athletes and for the people whose occupation demands them to be active on their feet. This test is very important to evaluate the condition of ankle ligaments.

TREATMENT PART 

There are many types of ankle fractures. Treatments vary significantly depending on the location, type of bone broken and severity of the injury. Stable fractures are treated similar to ankle sprains. All other types require surgery, ORIF (open reduction and internal fixation) It is usually carried out with implanted metal hardware (plate and screws) that holds the bones in place while the healing of bones occurs naturally. A cast or splint will be required to immobilize the ankle following surgery.

YOU SHOULD KNOW THIS

    

1. In case of dislocation your doctor will do the reduction (locating the bone back into place). It is very important to do it as soon as possible to prevent the problems regarding nerve and blood vessel supply to the foot. Depending on the amount of pain and swelling, the doctor will give you painkillers, muscle relaxants or even anesthesia before the procedure.

He will give you a splint to protect your ankle and to keep the bones in correct positions. Then he will decide whether the surgery is required or not, or you will be alright with support of a cast to let it heal naturally.

2. If surgery is not advised (cases of closed, non displaced #) then your fracture will require a cast at least for 4- 6 weeks. Doctor gives back-slab cast for stabilization and elevation of injured foot (keeping the ankle raised) is advised to reduce the swelling.

Once it is removed, you will be advised for physical therapy before resuming your normal activities. 

3.  Surgery is advised mostly in unstable fractures to realign the bones and fix them in position. The surgeon may use metal plates, screws, nails and wires to hold the broken bones together. The wound is closed using stitches. The metal work is not removed unless it becomes a problem. This whole procedure is done under general or epidural anesthesia.It is difficult to judge the duration of total recovery as it depends on severity of injury and your lifestyle.

4. Mostly your surgeon will advise hospital stay for 2-3 days after surgery. My experience says you should stay for 4-5 days as you get enough rest. Post surgical pain will also bother you a lot. I had very bad contracting pains 2 hours after surgery and it continued at least for 3 days. In this period, painkillers will be your best friends. Without them it will be impossible to survive.

5. A plaster cast will be placed on your ankle before you go home.

CAST

Most ankle fractures require a cast or a splint for around 6 – 8 weeks. Immobilization is strictly advised for the first few weeks. So you will have to use either a walker or crutches for support as you are not allowed to put weight on the injured leg. In some cases the doctor might give a walking plaster – depending on the type of ankle fracture (walking is allowed in some cases).

Do follow up visits sincerely with your doctor. He can advise you the important things which help your ankle to heal. Serial x-rays may be advised to make sure healing is taking place.

POSSIBLE EARLY COMPLICATIONS  : 

• Diabetic patients, smokers and elderly persons are at a higher risk for complications after surgery. It may take longer time for their bones and wound to heal.
• Osteomyelities - It is a bone infection , mostly seen in open # 
•  Nerve and blood vessel damage especially after a displaced #   
• Compartment syndrome - It means severe swelling and pain in the leg immediately after injury. Mostly happens in high impact injuries such as car or bike accidents.
• Damage to the skin and soft tissues because of tight cast 
• Burns to the skin as the plaster hardens.
• Thrombophlebities – inflammation of veins of the lower leg.
• Failure of bones to unite together and heal well.
• Temporary complications of wearing cast - thinning of bones and wasting of muscles, can occur even in 4-6 week period of casting.
• DVT (deep vein thrombosis)– clotting of the deep veins which can relate both to reduced mobility and to pressure on the leg veins from swelling and casting. 

POSSIBLE LATER COMPLICATIONS INCLUDE:

·         Osteoarthritis of ankle joint.

·         Loss of flexibility and stiffness in the ankle.

RUSH TO THE HOSPITAL

      1. If your ankle is swollen too much

      2. Any problem with plaster cast (either you feel very tight or loose)

      3. If you get numbness or burning in toes

      4. If your skin around the ankle turns blue

      5. Any foul smelling discharge from the surgical wound

      6. Excessive pain in your ankle

Above signs may indicate infection or damage to the nerves or blood vessels which can affect the blood supply to the ankle.

HOW TO PREVENT SUCH INJURIES

• Exercise - It is very important to strengthen your knees and ankles. If you are prone to twist your ankle then you should do the strengthening exercises regularly for your ankle muscles. Simple walking is also good exercise.
• Wear Ankle Supports - This definitely helps to prevent sprain or break by supporting ankle muscles.
• Wear proper footwear - wearing a wrong one increases your risk of falling.  So wear proper shoes, neither too big nor too small.
• Walk on flat road -  There are chances of tripping on uneven surfaces. 
• Many fractures are result of walking in the dark (Like mine). So use nightlights.
• Keeping clutter off the floor can help you to avoid trip and falls. (no piles of clothes or boxes). 
• Lose weight if you are obese, overweight - losing weight decreases the strain and pressure to your ankle and it also makes your ankle stronger.
• Strengthen your bones by eating Calcium rich foods such as milk, yogurt, cheese etc and also Vit D supplements.
• Keep yourself more active physically. Do weight bearing exercises, resistance exercises, and flexibility and balance exercises regularly after consulting your doctor.

JUST HANG ON. Do not give up. My next post will be about my broken ankle story and  role of homeopathy medicines in my recovery. Thanks for reading my blog. See you soon; wish you a safe and speedy recovery. Hope this helps you................

                                                                                                                   -  Dimple