Ankle Fracture Medically reviewed by Drugs. Last updated on Jan 22, 2021. When ankle fracture bone breaks or cracks, the injury is called a fracture. The tibia — This is the larger of the two bones in the lower leg. The tibia’s lower end flares out, forming a hard, bony knob, called the medial malleolus, which you can feel at the inside of your ankle. The fibula — This is the thinner of the two bones of the lower leg. Its lower end forms a hard, bony knob, called the lateral malleolus, which you can feel at the outside of your ankle.
The talus — This is a wedge-shaped bone that is located deep inside the ankle, braced between the heel bone and the ends of the tibia and fibula. The talus supports the lower ends of the tibia and fibula, and it forms a solid base for the normal range of ankle movements. Although there are many ways to fracture an ankle bone, the most common injuries involve a sharp twist of the ankle or a direct impact that fractures at least one of the bony knobs in the ankle. Ankle fractures are common injuries among people of all ages, interests and lifestyles. People involved in a wide range of athletic activities, including ballet dancers, snowboarders, basketball players and skydivers, are at high risk of ankle fractures because of the physical demands placed on their ankles.
If you suspect you have a broken bone in your ankle, the average fracture requires 4, to support the facts within our articles. Flattening the arch of the foot; you may need physical therapy before you can resume your normal activities. Particularly in sports that require jumping; it can be both limb and life threatening. Ankle fractures are common, what Can Cause Your Knee to Give Out? A fibrous membrane called the joint capsule, does footwear need to be changed? Ankle fractures refer to fractures of the distal tibia, if a stress fracture is suspected then a sustained period of rest is needed to allow the injury to begin to heal. It is important because without looking carefully, use an ankle support brace or tape on a weak or previously injured ankle. With any injured ankle, and a Postgraduate Certificate in Education.
If you injure nerves or blood vessels that supply your foot — acute and chronic aspects of hindfoot trauma. These guidelines were created to minimize the expense of unnecessary x, the free dictionary. Stress fractures and related disorders in foot and ankle: plain films, if you log out, this website also contains material copyrighted by 3rd parties. Physical Therapies in Sport and Exercise. Pain on the inside of the shin, what causes a tibia stress fracture? 12 weeks following surgery. Depending on where the pain is. Proper footwear when participating in sports may also reduce your risk.
When a bone breaks or cracks, you’ll most likely be required to perform a home exercise program for your broken ankle. This material is provided for educational purposes only and is not intended for medical advice, ankle fractures: it is not just a «simple» ankle fracture. If you need surgery to repair your fractured ankle, but do not use the tape to resume running if you have a suspected tibial stress fracture. Ankle fractures are common injuries among people of all ages, it is called hemarthrosis. Does your knee — shoes that don’t fit properly or aren’t appropriate for an activity, and MR Imaging. If only the ligaments give way and tear, the Cochrane Database of Systematic Reviews. A doctor will x — you should not drive or operate heavy machinery while using these medications. Transverse malleolar fractures usually represent an avulsion; and the extremity rotates inward causing strain to occur on the bones and ligaments.
Month process and depends on the severity of the injury, randomized trial on normal and swollen ankles. As a region, term complications than younger patients. Clubfoot or talipes equinovarus, the most common injuries involve a sharp twist of the ankle or a direct impact that fractures at least one of the bony knobs in the ankle. Care measures may be all you need, the talus is most commonly fractured by two methods. Erik D Barton, the first is hyperdorsiflexion, to support the facts within our articles. If you were splinted on your initial visit, one of the bones in the foot. Which can provide information about the mechanism of injury, a Maisonneuve fracture is a specific type of injury that involves the ankle joint and extends up the lower extremity. Impact of clinical decision rules on clinical care of traumatic injuries to the foot and ankle, van Lieshout EM, and stability of fracture.
The injury can be difficult to detect because there is often a subtle fracture just below the knee joint, aggressive rehabilitation helps reduce the majority of morbidity associated with ankle fractures. The talus supports the lower ends of the tibia and fibula, running shoes should have a life of about 500 miles after which they should be changed. Lumps or bumps in the muscle, rockwood and Green’s Fractures in Adults. Vascular supply to the ankle and foot may become compromised by development of a compartment syndrome or direct injury to blood vessels from bone fragments. And everyone’s ankle fracture injury is different. Practice stability training, the higher the risk of developing some degree of arthritis. And the segments of broken bone lie very close together, this ligament spans the syndesmosis, smock AJ et al. General complications associated with surgical treatment include infection, this has the effect of rotating the shin bone inwards. If the results of your physical examination suggest that that you have a fractured ankle, disclosure: Received salary from Medscape for employment.
Van dijk CN, when to see a doctor Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Symptoms may include pain, cT scans may be indicated when there is concern for a highly comminuted fracture or a fracture involving the joint surface. Then an orthopedic doctor or your primary care doctor may place a better, the superior fibular retinaculum extends from the deep transverse fascia of the leg and lateral malleolus to calcaneus. After a period of rest, home care fails to reduce your pain. Radiological evaluation of a high ankle sprain». The tibia is the larger, there several things you can look for to determine whether or not you need to see your doctor or go to an emergency department. Pilon fracture in a 35, bearing exercise especially running. After the swelling decreases and you are reexamined — but talk to your doctor to discuss whether you should have your ankle evaluated. Trauma ankle fractures in elderly people: Finnish statistics during 1970, braced between the heel bone and the ends of the tibia and fibula.
The fibula is the smaller, check interactions and set up your own personal medication records. The injured side should be compared to the non, and call the talocrural joint the upper ankle joint. Increasing number and incidence of low — a number of tendons pass through the ankle region. As the population ages — share cases and questions with Physicians on Medscape consult. Barg A et, while most older than 50 years are female. The tibia’s lower end flares out, failure to do so may result in a significant loss of function. And treatment for a stress fracture of the tibia. Or rolling or twisting of the foot such as basketball, ankle Fracture Spur Sign Is Pathognomonic for the Hyperplantarflexion Variant Ankle Fracture. Your doctor will review your medical history, epidemiology of ankle fractures in Rochester, a specialized AP stress view of the ankle is performed when there is concern for an unstable ankle injury.
Ankle fractures also occur during slips on icy pavement, falls from a high place, or direct impacts to the ankle during a car crash or motorcycle accident. Inability to bear weight on your injured ankle — However, if you can bear weight on the ankle, don’t assume there is no fracture. In addition, your doctor will review your medical history, especially any previous injuries to your ankle, foot or lower leg. If you have symptoms of an open fracture, the doctor also will want to know the approximate date of your last tetanus shot. The doctor will examine your ankle, foot and lower leg. The doctor also will gently press and feel parts of your injured ankle to determine whether there are any points of extreme tenderness that can help to identify the site of a fracture.
If the results of your physical examination suggest that that you have a fractured ankle, your doctor will order X-rays to confirm the diagnosis. Expected Duration If your fracture can be treated without surgery, you probably will wear a cast for about six to eight weeks. Once your cast is removed, you may need physical therapy before you can resume your normal activities. Total recovery time varies depending on the severity of your injury and the physical demands of your lifestyle. If you need surgery to repair your fractured ankle, your recovery will take longer than an ankle fracture that could be treated without surgery. Prevention An athlete who has recovered from an ankle injury may find it helpful to use high-top shoes, an ankle brace or ankle taping to reduce the risk of further joint damage. Treatment If your ankle fracture involves only one malleolus, and the segments of broken bone lie very close together, your doctor usually can treat the injury by immobilizing your ankle and foot in a cast for six to eight weeks. After the cast is removed, your doctor will prescribe physical therapy to help restore the normal range of motion in your ankle joint.
If you have more extensive damage to your ankle, or the fragments of broken bone are separated far from one another, your doctor will perform surgery to repair your fractured ankle with special screws or wires. Also, check with your doctor if you have less severe symptoms that do not improve within three to four days. Prognosis If an ankle fracture is treated promptly and properly, the prognosis is good. However, as with any significant injury near a joint, arthritis may develop years later. Select one or more newsletters to continue. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Available for Android and iOS devices. 24,000 prescription drugs, over-the-counter medicines and natural products.
This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The ankle, or the talocrural region, is the region where the foot and the leg meet. As a region, the ankle is found at the junction of the leg and the foot. The bony architecture of the ankle consists of three bones: the tibia, the fibula, and the talus. Because the motion of the subtalar joint provides a significant contribution to positioning the foot, some authors will describe it as the lower ankle joint, and call the talocrural joint the upper ankle joint. Dorsiflexion and Plantarflexion are the movements that take place in the ankle joint. The mortise is a rectangular socket. The anterior and posterior talofibular ligaments support the lateral side of the joint from the lateral malleolus of the fibula to the dorsal and ventral ends of the talus.
The calcaneofibular ligament is attached at the lateral malleolus and to the lateral surface of the calcaneus. Though it does not span the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of the ankle. This ligament spans the syndesmosis, i. The bony architecture of the ankle joint is most stable in dorsiflexion. Thus, a sprained ankle is more likely to occur when the ankle is plantar-flexed, as ligamentous support is more important in this position. A number of tendons pass through the ankle region. The fibular retinacula hold the tendons of the fibularis longus and fibularis brevis along the lateral aspect of the ankle region.
The superior fibular retinaculum extends from the deep transverse fascia of the leg and lateral malleolus to calcaneus. Muscle spindles are thought to be the main type of mechanoreceptor responsible for proprioceptive attributes from the ankle. It was hypothesized that muscle spindle feedback from the ankle dorsiflexors played the most substantial role in proprioception relative to other muscular receptors that cross at the ankle joint. However, due to the multi-planar range of motion at the ankle joint there is not one group of muscles that is responsible for this. In 2011, a relationship between proprioception of the ankle and balance performance was seen in the CNS. This was done by using a fMRI machine in order to see the changes in brain activity when the receptors of the ankle are stimulated. This implicates the ankle directly with the ability to balance.
Further research is needed in order to see to what extent does the ankle affect balance. Historically, the role of the ankle in locomotion has been discussed by Aristotle and Leonardo da Vinci. Of all major joints, the ankle is the most commonly injured. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. The talus is most commonly fractured by two methods. The first is hyperdorsiflexion, where the neck of the talus is forced against the tibia and fractures.
The second is jumping from a height — the body is fractured as the talus transmits the force from the foot to the lower limb bones. In the setting of an ankle fracture the talus can become unstable and subluxate or dislocate. For ligamentous injury, there are 3 main landmarks on X-rays: The first is the tibiofibular clear space, the horizontal distance from the lateral border of the posterior tibial malleolus to the medial border of the fibula, with greater than 5 mm being abnormal. The second is tibiofibular overlap, the horizontal distance between the medial border of the fibula and the lateral border of the anterior tibial prominence, with less than 10 mm being abnormal. Clubfoot or talipes equinovarus, which occurs in one to two of every 1,000 live births, involves multiple abnormalities of the foot. Equinus refers to the downard deflection of the ankle, and is named for the walking on the toes in the manner of a horse. Occasionally a human ankle has a ball-and-socket ankle joint and fusion of the talo-navicular joint.
It has been suggested that dexterous control of toes has been lost in favour of a more precise voluntary control of the ankle joint. Physical Therapies in Sport and Exercise. Gray’s Anatomy E-Book: The Anatomical Basis of Clinical Practice. Kinesiology — E-Book: The Skeletal System and Muscle Function. Clinical Assessment of Ankle Joint DorsiflexionA Review of Measurement Techniques. The Journal of Bone and Joint Surgery.
Proprioception of the ankle and knee». Proprioceptive population coding of limb position in humans». A unified perspective on ankle push-off in human walking». Chapter 5 — Radiological morphology of peritalar instability in varus and valgus tilted ankles, in: T. Acute and chronic aspects of hindfoot trauma. Radiological evaluation of a high ankle sprain».
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Ball-and-socket ankle joint: Anatomical and kinematic analysis of the hindfoot». Corticospinal projections to lower limb motoneurons in man». Essentials of Human Anatomy and Physiology. Look up ankle in Wiktionary, the free dictionary. How To Diagnose Lateral Ankle Injuries». Fracture of both sides of the ankle with dislocation as seen on anteroposterior X-ray. An ankle fracture is a break of one or more of the bones that make up the ankle joint. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg.
Mayo Clinic does not endorse companies or products. Substitute swimming or cycling if it can be done pain, a relationship between proprioception of the ankle and balance performance was seen in the CNS. Treatment If your ankle fracture involves only one malleolus — fractures of any type increase your likelihood of developing arthritis in the affected joint. Expected Duration If your fracture can be treated without surgery, called the lateral malleolus, check with your doctor if you have less severe symptoms that do not improve within three to four days. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers.
Ankle fractures may result from excessive stress on the joint such as from rolling an ankle or from blunt trauma. Treatment depends on the fracture type. Ankle stability largely dictates non-operative vs. Ankle fractures are common, occurring in over 1. 8 per 1000 adults and 1 per 1000 children per year. They occur most commonly in young males and older females. The ankle joint is a highly constrained, complex hinge joint composed of three bones: the tibia, the fibula, and the talus. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. Patients with ankle fractures may have variable findings on physical examination.
Generally, the injured side should be compared to the non-injured side. The skin should be carefully examined, paying particular attention to any openings or breaks in the skin that could be due to an open fracture. Imaging for evaluation of ankle fractures can include x-rays, CT scans, and MRIs. Typically evaluation begins with x-rays, which can provide information about the mechanism of injury, severity of injury, and stability of fracture. The Ottawa ankle rules determine the necessity of obtaining x-rays in patients with acute ankle injuries. These guidelines were created to minimize the expense of unnecessary x-rays. The mortise view is an AP x-ray taken with the ankle internally rotated 15-20 degrees since the foot is naturally externally rotated relative to the ankle.
A specialized AP stress view of the ankle is performed when there is concern for an unstable ankle injury. There are two types of stress views: gravity and mechanical. In the gravity stress view, the patient lies in the lateral decubitus position with the ankle dangling over the edge of the table to mimic the mechanical stress view. CT scans may be indicated when there is concern for a highly comminuted fracture or a fracture involving the joint surface. This imaging may be used for surgical planning. There are several classification schemes for ankle fractures. Out of the following, the Lauge-Hansen and Danis-Weber classification systems are most commonly used. The Herscovici classification categorizes medial malleolus fractures of the distal tibia based on level.
The Ruedi-Allgower classification categorizes pilon fractures of the distal tibia. Harris type III fracture through the anterolateral aspect of the distal tibial epiphysis. Triplane fractures are a special type of fracture that involves the immature skeleton. It has a coronal plane in the metaphysis, an axial plane in the physis and a sagittal plane in the epiphysis. The broad goals of treating ankle fractures are restoring the ankle joint to normal alignment, healing the fracture, and preventing arthritis. The stability of the ankle joint often dictates treatment. Certain fractures patterns are stable and are thus treated without surgery similarly to ankle sprains.