The inner ankle fracture is an injury at the lower end of the shin.
The lower leg is formed by two adjacent tubular bones: tibia and fibula.
The shin is located in the front area of the lower leg.
Together with the femur, it forms the knee joint and with the calf and ankle bone the ankle joint.
The shin has a pronounced bone protrusion on the inside, which is called the inner ankle (malleolus medialis).
On various occasions, e.g. when sitting down after a jump or when turning the ankle joint, force is exerted on the shin and inner ankle.
If this force exceeds the resistance of the bone, the inner ankle can break.
Fractures of the inner ankle differ by the position, extent and type of fracture.
Possible forms of fracture: demolition fracture (avulsion fracture), fatigue fracture (stress fracture), pot fracture, undisplaced, displaced, open, incomplete fractures, debris fractures, etc.
Contents
Causes
Since the fracture of the shin requires a great deal of force, an inner ankle fracture often occurs in conjunction with other injuries, such as ankle sprain or other fractures to the foot.
It can also be caused by clumsy touchdown after a jump (especially on uneven ground), as a result of a fall or by a direct blow to the front or side of the lower leg or ankle.
Inner ankle fractures often occur when running and jumping, or during sports that involve frequent changes of direction, such as football, rugby, basketball, and tennis.
The inner ankle can also break as a result of overload, one speaks of a fatigue fracture or a stress fracture; this often happens through intensified sporting activity or excessively long training sessions.
Signs and symptoms of an inner ankle fracture
At the moment of injury, the affected person feels a sudden, intense paininside the ankle and/or lower leg. Often the patient limps to spare the inner ankle.
In more severe cases, especially with displaced fractures, the patient is not able to load the injured leg.
As a rule, the pain occurs at the front or inside of the ankle and/or lower leg.
When immobilized, the symptoms can quickly subside; pain remains at the point of fracture, which becomes stronger at night or in the morning when getting up.
Only rarely do symptoms occur in the area of the Achilles tendon.
Patients with inner ankle fracture have swelling and bruising and experience pain when the broken bone is touched.
The pain intensifies with certain movements of the foot and ankle or when walking and standing.
In the case of serious (displaced) fractures of the inner ankle, a significant deformity may be visible.
Other complaints include tingling or numbness in the lower leg, foot or ankle.
Diagnosis
Most patients with an inner ankle fracture immediately go to the emergency room of a hospital.
There, an X-ray is first taken to examine the fracture shape and to determine whether the bone pieces are displaced, whether there is a debris fracture and to analyze the condition of the bone.
Often, inner ankle fractures occur along with the following injuries:
- fibula fracture (outer ankle),
- fracture of the posterior shin edge (Volkmann triangle),
- lesion of the ankle ligaments.
Conservative treatment
If the fracture is not displaced or remains limited with a minor lesion, surgery can be dispensed with.
In this case, the therapy consists of immobilization by plaster or orthosis.
As a rule, the leg must not be fully loaded for about 6 weeks.
It must continue to be x-rayed regularly to ensure that the position of the fragments has not shifted.
Surgical treatment
If the fracture is displaced or the ankle joint is unstable, the surgeon will recommend surgical treatment.
In some cases, surgical intervention is also considered in the case of an undisplaced fracture, because this can also reduce the risk of a lack of bone healing and the ankle joint can be moved earlier again.
If the inner ankle is broken, the ankle joint can also be squeezed.
This happens when the acting force is so great that the bone ends are pressed into each other.
For the repair of such a fracture type, a bone transplant may be necessary.
This creates a new skeleton that can grow back and reduces the risk of arthritis.
Depending on the fracture shape, the bone fragments can be fixed with screws, a plate and a few screws or with various techniques using Kirschner wires.
The orthopedist gives his consent to the loading of the ankle joint, if the healing process allows it.
The load on the broken leg must be gradual, initially a partial load with a removable plastic orthosis and forearm walkers up to full load without aids.
Swelling is quite normal with a broken ankle.
A drainage massage and high position of the affected ankle are extremely effective decongestant measures.
The compression exerted by a Walker orthosis stimulates fluid absorption in the ankle joint.
The inflatable air cushions of the Walker orthosis made of plastic massage the leg while walking and contribute to the decongestion.
An orthosis also has the advantage of maintaining the general state of health, because with its help static exercises and lifting weights are possible with the training equipment of a sports hall.
Even if the fracture has already healed, the doctor may recommend wearing an ankle bandage for a few months to practice sports activities; however, this must not become a habit and cause psychological dependence.
Complications of an ankle fracture:
- injury to soft tissue and skin,
- lack of consolidation,
- axis misalignment and loss of fixation,
- infection,
- post-traumatic arthritis, often with bad fracture treatment,
- tibiofibular synostosis (merging of tibia and fibula),
- deep vein thrombosis,
- In diabetics with concomitant pathologies, complications occur more often: a higher rate of death in the hospital and a longer hospital stay.
The surgical risks are: residual pain, partial recovery of joint functions, missing or poor consolidation, painful synthesis agents, compartment syndrome, deep vein thrombosis, infection, axis malposition, loss of reposition, displacement of the synthesis agents, anesthesia risks, heart attack and death.
Prognosis for inner ankle fracture
Patients with inner ankle fractures can restore their original state of health one hundred percent with appropriate (conservative or surgical) treatment.
The return to professional and sporting activities takes between 6 weeks and a few months and should be accompanied by the physiotherapist or doctor.
In patients with severe injuries that have caused damage to other bones, muscles, nerves or blood vessels, recovery times are much longer.
Patients with smaller and undisplaced fractures (e.g. demolition fractures) can in some cases become active again after 8 weeks under the supervision of the physiotherapist.
Rehabilitation
If the ankle joint is allowed to be moved again, physical therapy must be performed, as well as an exercise program at home, so that the original state of health can be restored well and quickly.
Magnetotherapy can shorten bone consolidation times by up to 50% and can still be started with gypsum.
The key to treatment lies in the regular implementation of exercise therapy (physiokinesiotherapy).
This is followed by proprioceptive movement training to regain mobility and postural control.
The exercises for the ankle joint are excellent for regaining the range of motion; at an advanced stage, stress exercises can be performed with the fitness band to strengthen muscle strength.
The physiotherapist instructs the patient to walk normally without limping.
Once muscle strength has been restored and flexibility and balance are just as pronounced as on the healthy side, functional training can be carried out, which includes running exercises and specific sports techniques.
It may take a few months until the muscle strength of the lower leg and calf is restored, forearm walkers are no longer needed and normal everyday activities can be resumed.
Load
The doctor decides on a case-by-case basis when the foot may be loaded again.
A first partial load can occur if the bone has sufficient stability.
If the ankle joint is loaded too early, the fracture fragments may shift and a new operation may be necessary.
Prevention
Unfortunately, little can be done to prevent an inner ankle fracture.
Shin pads should definitely be worn in football to reduce the risk of fractures caused by direct violence.
A fatigue fracture of the inner ankle can occur as a result of overload; this often happens through intensified sporting activity or excessively long training sessions. The doctor decides on a case-by-case basis when the foot may be loaded again.
