In the more experience snowboarders, the ankle seems to the most
prevelant site of injury. It is found that the ankle is more often
injured in the leading leg, as well as those who wear Soft-Shelled
boots. Most of the injury are 'sprains' and only a few are fractures.
ANKLE SPRAINS
Ankle sprains are basically injuries to the ligaments and soft
tissues around the ankle. They result from movement of the ankle
joint in a variety of directions:
- This is when the foot turns inwards, and this usually results
in injury first to the lateral(outer)aspect of the ankle.
-
- This is when the foot turns outwards, and the initial source
of problem is in the medial (inner) of the foot.
It should be remembered there can also be a rotational element
to this injury, hence if the force is great enough resutling in
both aspects of the ankle joint becoming involved.
Clinical Features
- Pain. Pain is usually over either of the two bony aspects
of the ankle. The pain is worse on movement and attempting to
weight-bear. This pain can vary from burning to a sharp sensation.
- Swelling. There can be a great amount of swelling around
the ankle joint. This can be associated with considerable amount
of bruising.
- There can be a great amount of swelling around the ankle joint.
This can be associated with considerable amount of bruising.
- Tenderness. Touching of the area will will result in
a variable amount of discomfort.
It should be stressed that it can be difficult to differentiate
at times between a fracture of the ankle and a severe bruising.
The ankle may seem mildly painful, with a hint of swelling but
an X-ray shows the presence of an underlying fracture.
Management
- Exclude a fracture.
- Elevate. The limb should be elevated at rest as to
allow gravity to reduce the swelling. This also helps in reducing
the amount of discomfort.
- Rest. Rest reduces the amount of stress on the injured
ligaments and allows a more painless recovery.
- Strapping. Strapping of the ankle with crepe bandage
or Tubi-grib, helps support the ankle, recudes the amount of swelling
and discomfort.
- Gradual mobilise. It is important that once the initial
stages of pain have reduced to start mobilising the ankle as to
prevent stiffness developing within the joint.
In some situations the pain and discomfort is such that even though
there is no evidence of a fracture, the ankle is immobilised for
a couple of weeks in plaster. In these situations, the integrity
of the ligaments should be assessed, as there may be an underlying
complete rupture of the collateral ligaments.
ANKLE FRACTURES
1
2
3
4
The above X-rays show a few types of ankle injuries which are
sustainable if the necessary force and determination are applied.
Mechanism
Mechanism of injury in ankle fractures usually is when the foot
is anchored to the ground and the momentum of the body continues
forward; ie when boarding your board comes to a stop, when you
fall, and the body goes forward.
There is also the fall from a height where the foot is driven
upwards into the Tibia.
There are a variety of classifications of the fracture of the
ankle, depending on the anatomy, stability.
Clinical Features
- Pain. This can be on either/both sides of the ankle
- Swelling. There is a variation in the amount of swelling,
and there may be an associated deformity.
- Ankle fractures usually are intra-articular, and hence the
articular suface has to be re-aligned to prevent any future problems
eg. Osteoarthritis.
- As the swelling is rapidly in onset, the treatment should
be initiated rapidly, as final treatment may be delayed for several
days to allow this swelling to reduce.
- Reduce. The fractures may be aligned by manipulation
under anaesthesia, or in more complex ones require an open procedure
to bring the ends approximated as best as possible. If this is
embarked, it usually involves plates and screws inserted to hold
the fragments.
- Hold. Following either method the ankle is
immobilised in plaster for 6-8 weeks. This time period is variable,
as the important feature is to allow the fracture to heal.
- Movement. Following either management, it is
important following removal of the plaster that the ankle is excercised
as much as possible. The ankle is then placed in a temporary
crepe bandage following removal of the plaster.
- If the fracture is undisplaced, below the ankle joint or in
the elderly these can be treated with plaster of paris.
- A padded plaster is placed from below the knees to the toes,
with the foot in a downward(plantigrade) position. Initially
the plaster maybe split, or an incomplete plaster placed to allow
room for the swelling following the injury room. Once the swelling
is reduced the plaster is completed.
An overboot is fitted in patients with stable fractures or later
in the treatement, and taught to walk correctly.
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