A fracture is a partial or complete break in a bone. According to the American Academy of Orthopedic Surgeons, a fractured ankle means that one or more of the bones that make up the ankle joint has separated into pieces. There may be ligaments damaged as well. Most ankle fractures require urgent medical care. Without appropriate treatment, many fractures will not heal properly or will have unnecessary complications.
Treatment for Stable Fractures
If an ankle fracture is considered a stable fracture, meaning the fracture is not out of place or just barely out of place, treatment may not require surgical intervention. A stable fracture may be treated with a commercially prepared ankle splint, a splint made from casting material or a short leg cast. The choice of treatment will also depend on where the break in the bone is located. The ability to bear weight will be determined by the physician based on the break. Crutches may be necessary.
Treatment for Unstable Fractures
If the fracture is out of place your ankle is unstable; your fracture may be treated with surgery. To make your ankle stable, a combination of plate and screws or a rod inside the bone may be used to realign the bone fragments and keep them together as they heal. This type of surgery is called an open reduction and internal fixation. Fractures that require surgical intervention will generally have a period of time in which no weight bearing is allowed. Time frames can vary from six weeks and up. Partial weight bearing is started prior to allowing any full weight bearing. During this period the patient will require the use of crutches, wheelchair or walker.
Open Ankle Fractures
An open ankle fracture is one where bone is exposed through the skin to the environment. Open fractures will require immediate surgical intervention. These fractures have a high risk of infection.
Treating the Pain
Pain control is an essential part of the treatment in ankle fractures. Providing pain medication ensures patient comfort. Pain management promotes improved physical therapy compliance and allows the patient to return to her optimal level of functioning. In addition to medications, ice and elevation are important interventions with fractures. Ice and elevation will help to decrease the swelling of the extremity and help with comfort.
Rehabilitation Treatment
Regardless of how the ankle fracture is treated, rehabilitation is important. Once your physician allows you to start moving the ankle he may prescribe a combination of home exercises and physical therapy. Strengthening exercises will be implemented as rehabilitation progresses. It may take several months before your ankle feels strong enough to return to your regular activities.
Complications and Risks
If surgery is necessary, the most common complications would include potential for infection, bleeding or damage to nerves and tendons. Longer-term complications following surgical intervention may be difficulty with bone healing and arthritis. In patients who have had plates and screws placed, they may experience some discomfort and choose to have them removed once the bones have healed after several months. Patients who are elderly, have diabetes or are smokers are at higher risk because these complicate wound healing.
References
- "Clinical Practice of Emergency Medicine"; Lippincott Willams & Wilkin 5th ed; 2010
- "Orthopedic Nursing"; Ankle Sprains and Fractures in Adults; Small; Nov / Dec 2009
- "Sheehy's Manual of Emergency Care"; Elsevier Mosby 6th ed; 2005
