Outer ankle fracture

introduction

An outer ankle fracture is one Fracture of the fibula (Fibula) in the area of ​​the ankle. This break occurs especially in one Buckling of the foot and with a high force. The lateral malleolus fracture is one frequent sports injury, especially in sports with abrupt stopping movements and short sprints.

This fracture occurs and goes with both older and younger people severe stabbing pain hand in hand. In addition to the outer ankle fracture, ankle twisting of the foot can also cause sensitive ones Tapes tear of the ankle. There are also combined internal and external malleolus fractures.

Symptoms

A leading symptom of the lateral malleolus fracture is severe pain immediately after the trauma.
These pains usually exist at rest, but they can mainly be triggered by putting pressure on the foot or passively by pressure on the ankle.
Due to the pain and the fracture of the ankle, treading on with the foot and thus walking is difficult or even impossible.

Read on under: Outer ankle pain

Sometimes an external malleolus fracture is also noticeable by an abnormal position of the ankle.
This misalignment can result in the broken ankle being displaceable in relation to the foot, i.e. instability and excessive mobility of the foot, which would not be possible with an intact ankle.

In addition, so-called crepitations, i.e. noises caused by bone rubbing, indicate the presence of an external malleolus fracture. The crepitations arise either from active attempts to move the foot or can also be caused by its passive movement. On the one hand, these crepitations can be heard, but on the other hand, they can also be felt as rubbing with the hand on top. Within minutes to hours after the trauma, the blood vessels around the ankle are injured, bleeding under the skin and consequently swelling of the ankle and, later, a bruise (Hematoma). If nerves are injured as a result of the outer ankle fracture, this can lead to sensitivity disorders of the skin in the area of ​​the foot.

Read more on the subject at: Outer ankle fracture symptoms

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My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Diagnosis

If the Suspicion insists on an external malleolus fracture becomes a classic first X-ray image made in two planes of the ankle to primarily the bony structures to assess and find out whether there is actually a fracture or just one ankle sprain.
The X-ray image can also be used to plan the subsequent therapy and determine whether an operation is necessary.

For a more precise assessment of the fracture, a CT examination be necessary.
If there is any suspicion of a Injury to ligament structures can also be a MRI examination to be necessary. However, this must always be decided on a case-by-case basis.

therapy

surgery

A therapy by a surgery the lateral malleolus fracture is indicated whenever larger vessels or nerves damaged by the break and it too Loss of sensitivity has come.
The fracture must also be treated surgically, if a open ankle fracture is present, i.e. when the skin has been destroyed by the break and parts of the bone may even protrude from the skin.
Here is high risk of infection and the ultimate goal of the operation is that Supply of the surrounding soft tissue like the muscles.

Furthermore, the fractures of the outer malleolus, in which the bone fragments, must be operated shifted against each other are so no healing through growing together these fragments possible is.
This is mostly the case with Weber C fractures.

So the goal of the operation is a Preservation of the surrounding soft tissue and also one exact restoration the anatomical features of the bones with regard to their Axis, position and length.
In general, an operation on the lateral malleolus fracture should be possible within six hours of the trauma otherwise the swelling will be too strong.
If this time window is missed, you have to wait until the swelling of the ankle has subsided is what can take about three days to a week.

The operation of an external malleolus fracture is performed in General anesthesia (general anesthetic). First, after opening the skin over the ankle, the bone fragments are returned to their physiological position.
In order to maintain this position of the bone fragments in relation to one another, they are made using Screws, wires and plates made of metal fixed together.
Then a drainage, i.e. a tube that is supposed to convey wound water out of the operating area, is inserted and the wound is sutured. After a day or two, the drainage will be removed again.

After the operation it is necessary to close the foot for six weeks immobilizewhat means plaster is achieved.
You can only load part of your body weight on your foot, which is why you should walk crutches should use.

After the plaster is removed, the physiotherapy very important. About a year after the first surgery is one renewed operation necessary, in which the inserted screws and plates can be restored after the bones have healed and grown together away become.

Without surgery

A conservative treatment of an external malleolus fracture, i.e. a non-surgical therapy, is used when the bone fragments are not shifted from one another and are adjacent to one another in such a way that they can grow together well. This is mostly the case with fractures of the Weber A type and sometimes also with Weber B fractures of the ankle that do not have any surgical indications, such as a nerve injury or an open fracture.

In conservative therapy, the foot is relieved by immobilization so that the bone fragments can grow together again.
In the past, the foot was usually immobilized using a cast that had to be worn for six weeks.

Today, however, support bandages or so-called aircast splints are used, in which, in addition to the function of immobilizing the foot, there is also an air cushion that is intended to cushion impacts or forces acting on the ankle. The immobilization in aircast or splint usually takes place after the swelling of the ankle has subsided and then lasts for six weeks, as with a cast. In the case of uncomplicated fractures of the Weber A-type, the splinted foot can be fully loaded directly again, which has enormous advantages for quality of life and mobility.

In the case of more complex fractures that are treated conservatively, only partial weight bearing should be placed on the foot in addition to the immobilization, i.e. no load due to the full body weight.
Crutches are used for about four weeks. After an X-ray check of the foot, which ensured that the bone fragments are in a good position to each other and may even have partially grown together, the foot can then also be loaded with the full body weight in this case and the crutches are no longer required.

In the conservative treatment of an external malleolus fracture, the so-called PECH rule is also used, in which the principles of pause, ice, compression and elevation are important.

• The pause (P) after the injury is ensured by splinting the foot.
• In addition, cooling the ankle with ice (E), which should be wrapped in towels to prevent direct skin contact and thus prevent frostbite, helps relieve pain in the ankle.
  The cooling also contributes to the swelling.
• The compression (C) with an elastic bandage or the splint also counteracts swelling.
• In addition, raising the foot (H) helps to protect it and prevents the swelling from becoming excessively large.

Finally, adequate pain therapy also plays a major role in the treatment of an external ankle fracture without surgery, which can be achieved with the help of painkillers such as diclofenac if necessary.

Read more on the subject at: External malleolus therapy

Duration of healing

The Durationwho have an external malleolus fracture cure required depends largely on that Severity and the resulting Therapy method from.
So you basically differentiate between one operational and one non-operational, so conservative therapy.
The non-operative therapy begins immediately after the injurious trauma and one of its most important components is immobilizing the foot with a cast or a splint.

However, if there is swelling of the ankle as a symptom of the outer ankle fracture, one should wait until the swelling has subsided before the definitive immobilization in a splint specially adapted to the foot or in a cast. The Recovery time of the swollen ankle takes average three days up to two weeks. This is followed by the Immobilization of the ankle, the six weeks should exist long.
After this time and the removal of the plaster or splint can slowly starting to build up again be started on the ankle and the foot.

Here comes physiotherapy is of great importance because the immobilization of the foot over a period of six weeks resulted in muscle breakdown in the leg, which now has to be compensated for again.

At a operational care In the case of the lateral ankle fracture, you also have to wait until the ankle has swelled up in order to operate.
After the operation the foot is immobilized in a cast for six weeks.
During this time, the Wound healing the surgical wound. Also with this method of therapy there is one after the removal of the cast Physiotherapy very important to the Muscle building and to regain the full range of motion as before the ankle fracture.

A difference the operative method towards the conservative is that required reoperation.
This finds one year after the first operation at the earliest instead and serves to remove the previously introduced metal in the form of screws and plates, which are no longer needed to fix the bone pieces because they have grown back together through healing. After this second operation, the Healing time only about two weeks, since only wound healing takes place here.

In summary, both surgical and conservative therapy lasts on average at least six weeksin which the external malleolus fracture through its Immobilization to restrict the quality of life leads.

However, it takes a lot more time for the ankle to be fully resilient, as there is only one after the healing is complete Getting used to the new stress with a gradual and slow increase in intensity.
Despite individual differences, it should be about Everyday stresses and strains two months after starting treatment like running or sports like swimming and cycling again problem-free and painless to be possible.
However, sports that place higher stress on the ankle should be paused for several months.