The ankle joint is a common site of fracture and dislocation injuries. The bones of the ankle joint are the tibia, fibula and talus. These bones can break in a wide variety of patterns and cause different types of complications. Overall, patients tend to recover very well after suffering an ankle fracture.
Compartment Syndrome
Compartment syndrome of the lower extremity is a condition where there is increased pressure within the bundled muscles of the lower leg. There are four compartments in the lower leg; anterior, lateral, deep posterior and superficial posterior. A tibia fracture is a condition that can lead to increased swelling and elevated compartment pressures. As pressures in the compartments elevate, there can be damage to the nerves and blood vessels. The lower leg becomes tense in the muscles. Treatment of compartment syndrome requires a fasciotomy procedure. A fasciotomy is the name of the procedure to open up the compartments to relieve the internal compartment pressure. Any delay in treatment can lead to long-term nerve and muscle injuries.
Delayed Union or Nonunion
Delayed union refers to a longer time for the initial fracture to begin to heal. In tibial fractures, there can be pain and bone movement at the fracture site for more than six months after the initial trauma.
Nonunion refers to lack of bone healing. This process can happen despite surgery.
Malunion
Malunion is when a fracture heals incompletely or in an imperfect position. Premature arthritis may occur as a result. Shortening of the bone may be a side effect of a malunion. A surgical procedure may have to be done to fix the bone shortening after a malunion.
Infection
Open fractures, where the bone penetrates through the skin, have a high rate of infection. Antibiotics are given for these types of fractures to help prevent infection. Infection can also occur after surgery and may lead to a nonunion of the fracture or necessitate the removal of the surgical hardware. The "Handbook of Fractures" edited by Dr Kenneth Koval of Dartmouth Medical Center and Dr Joseph Zuckerman of the NYU-Hospital for Joint Disease reports the infection rate of fractures that do not penetrate the skin, known as closed fractures, at less than 2%.
Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome
Reflex sympathetic dystrophy or complex regional pain syndrome is a complication after trauma with no known cause. Patients have pain out of proportion with the injury. The leg may become swollen, painful, and clammy. The syndrome is treated with early physical therapy, but may require other procedures for refractory cases.
Post-traumatic Arthritis
Post-traumatic arthritis refers to joint stiffness after a fracture. The arthritis is similar to osteoarthritis. It may develop years after a fracture. There may be decreased range of motion of the joint.
Neurovascular Injury
The initial injury can lead to injury to the neurovascular structures; nerves, arteries, veins. During a physical exam, these structures are assessed for function. The surgery can also lead to damage to these structures as they can be directly injured by the hardware or even compressed by positioning during surgery.
References
- "Sports Medicine Patient Advisor"; Dr. Pierre Rouzier; 2004.
- "AAOS Comprehensive Orthopaedic Review"; Dr. Jay Lieberman (ed); 2008.
- "Handbook of Fractures"; Dr Kenneth Koval, Dr Joseph Zuckerman (editors); 2006.
