Injuries to the ankle are among the most common lower extremity sporting injuries. The ankle joint is a complex joint formed by three bones. It consists of the tibia provides the major weight bearing surface where it joins the talus. The joint is saddle-shaped with the tibia contributing the medial malleolus and the fibula contributing the lateral malleolus. The weight bearing surface of the tibia and the inner aspect of the medial and lateral malleolus are covered with cartilage.
Ankle stability is conferred by the bony architecture as well as three distinct groups of ligaments: the syndesmotic ligaments, the lateral collateral ligaments, and the medial collateral ligaments. Sprains of the lateral ligaments of the ankle are the most common musculoskeletal injury in sports.
The major joint in the shoulder, called the gleno-humeral joint, is between the cup of the scapula (glenoid) and the ball of the arm (humeral head). This cup and ball are surrounded by the rotator cuff. The rotator cuff is made up of four muscles (the supraspinatus, infraspinatus, teres minor, and subscapularis) which work together to lift and rotate the arm at the gleno-humeral joint.
Fractures and sprains of the ankle occur primarily with rotation or translation of the ankle joint.
Patients with ankle sprains and fractures will have pain, tenderness, and swelling at the site of the injury.
In patients with ankle injuries, radiographs are taken in order to see if there is indeed an ankle fracture. Most patients are then placed in a splint or walking boot based on the injury pattern . Ankle sprains are most frequently treated without surgery. Initial rehabilitation consists of rest, ice, compression (elastic wrap), and protected weight bearing. For mild sprains, patients discontinue use of crutches as quickly as they can tolerate full weight on the ankle.
Physical Therapy consists of range of motion, exercises with isometrics, and proprioceptive retraining. Bracing or taping are usually used when patient return to sport and for mild sprains can be discontinued 3-4 weeks after returning to sport. For more involved sprains, bracing or taping programs and a supervised rehabilitation program are continued for 6 months. One year after injury, occasional intermittent pain is present in up to 40% of patients. Surgery is not usually necessary for ankle sprains, but can be recommended for patients with excessive hyper-mobility of the ankle joint.
Ankle fractures may require operative treatment based on the stability of the ankle joint which is related to the pattern of injury. Lateral malleolus fractures are the most common type of ankle fracture. While isolated fractures of the lateral malleolus can usually be treated without surgery, injuries involving the medial or syndesmotic complex of ligaments, or fractures involving the medial and lateral malleolus (bimalleolar fractures) typically require surgery to re-establish the bony architecture of the joint and confer ankle stability. Surgery for ankle fractures consists of one or two incisions placed on the lateral and medial aspects of the ankle over the site of the fracture. The bony fragments are re-positioned and held in place with a combination of plates and screws.
What to expect from an ankle fracture…
Most ankle fractures take about 6-8 weeks to heal, although pain will subside after 2-3 weeks. A splint, cast, or walking boot is necessary until a doctor recommends it be discontinued, usually at approximately 6-8 weeks. Patients treated operatively can usually return to bearing weight on the joint at 6-8 weeks. Return to sports is usually at 10-12 weeks, once the ankle has been rehabilitated.
The ankle fracture heals with new bone formation around the fracture site. For patients sustain an injury to the syndesmotic ligaments a second surgery is required at 4-6 months. This surgery consists of an same-day outpatient procedure where screws placed across the syndesmosis are removed.
Most people with ankle fractures have an excellent outcome with return to normal activities and a pain-free ankle at 6 months after injury. For those people who have surgery, the plate is occasionally bothersome, especially in very thin patients. The plate can be removed after complete healing of the fracture (usually no sooner than 9-12 months after the surgery).