ANKLE INJURIES

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:

• Inversion:

This is when the foot turns inwards, and this usually results in injury first to the lateral(outer)aspect of the ankle.

• Eversion:

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

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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.

• Management

• 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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