eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Fracture: Follow-up

Author: Phillip M Steele, MD, Consulting Staff, Primary Care Sports Medicine, Gem City Bone and Joint; Team Physician, University of Wyoming
Coauthor(s): John D Kelly IV, MD, Associate Professor of Orthopedic Surgery, Vice Chairman, Department of Orthopedic Surgery, Temple University; Consulting Surgeon, Temple Children's Hospital and Shriner's Hospital for Surgery
Contributor Information and Disclosures

Updated: Mar 9, 2009

Follow-up

Return to Play

Return to play depends on both the ankle fracture and the athlete. Motivated athletes can generally return to sports with documentation of fracture healing and return of normal strength and motion. The goal of rehabilitation should be symmetric range of motion and 85% of contralateral strength before returning to the sport.

The first phase of rehabilitation is restoration of motion and pain-free ambulation after cast immobilization. During the first several days after cast removal, crutch-assisted ambulation can assist the patient in gaining motion and in preventing ankle reinjury secondary to weakness. After the return of passive motion, active motion and active-assisted motion should begin, along with a strengthening program. Particular attention is devoted to the recovery of peroneal and gastrocnemius complex strength. Proprioception and balance training are also an important part of the overall rehabilitation program and have been shown to be effective in reducing the risk for recurrent ankle injury.

Complications

Nonunion or delayed union is the most common complication of ankle fractures requiring referral to an orthopedist.

Miscellaneous

Medicolegal Pitfalls

  • Failure to use the Ottawa ankle rules in assessing for the necessity of radiographic examination: Remember to inform the patient that associated fractures could be present and that persistent pain should be reevaluated.
  • Failure to identify associated ligament instability and/or other associated fractures at the time of the initial evaluation: Fractures, such as a fracture of the fifth metatarsal base or a Jones fracture (location at the metadiaphyseal junction at proximal fifth metatarsal), can be easily missed in an inversion ankle sprain. Osteochondral fractures of the talar dome are easily missed on routine radiographs. Therefore, persistent ankle pain may require additional imaging studies.
  • Failure to identify an open fracture: This can lead to significant morbidity, and inspection of any surface wound should be routine. If an open ankle fracture is confirmed or suggested, urgent referral to an orthopedic surgeon is indicated.
 


More on Ankle Fracture

Overview: Ankle Fracture
Differential Diagnoses & Workup: Ankle Fracture
Treatment & Medication: Ankle Fracture
Follow-up: Ankle Fracture
Multimedia: Ankle Fracture
References
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References

  1. Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. Jan 1995;77(1):142-52. [Medline]. [Full Text].

  2. Thordarson DB. Detecting and treating common foot and ankle fractures. Part 1: the ankle and hindfoot. Phys Sportsmed. Sept 1996;24(9):29-38. [Full Text].

  3. Clanton TO, Porter DA. Primary care of foot and ankle injuries in the athlete. Clin Sports Med. Jul 1997;16(3):435-66. [Medline].

  4. Tandeter HB, Shvartzman P. Acute ankle injuries: clinical decision rules for radiographs. Am Fam Physician. Jun 1997;55(8):2721-8. [Medline].

  5. Schwartz DT, Reisdorff E, Williamson B, eds. Emergency Radiology. New York, NY: McGraw-Hill; 1999.

  6. Wedmore IS, Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. Feb 2000;18(1):85-113, vi. [Medline].

  7. Yu JS, Cody ME. A template approach for detecting fractures in adults sustaining low-energy ankle trauma. Emerg Radiol. Feb 18 2009;epub ahead of print. [Medline].

  8. Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am. Feb 2009;91(2):333-9. [Medline].

  9. Zalavras CG, Christensen T, Rigopoulos N, Holtom P, Patzakis MJ. Infection following operative treatment of ankle fractures. Clin Orthop Relat Res. Feb 19 2009;epub ahead of print. [Medline].

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Further Reading

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Keywords

ankle fracture distal, distal ankle fracture, tibia distal fibular injury, medial malleolus, lateral malleolus, malleoli, tibial plafond, Ottawa ankle rules, OAR, broken ankle, sprained ankle, ankle sprain, ankle injury, distal fibular fracture, distal tibial fracture, malleolus fracture, lateral malleolus fracture, Danis-Weber classification, Danis-Weber fracture, Jones fracture, Salter-Harris classification, Salter-Harris fracture

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Contributor Information and Disclosures

Author

Phillip M Steele, MD, Consulting Staff, Primary Care Sports Medicine, Gem City Bone and Joint; Team Physician, University of Wyoming
Phillip M Steele, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

John D Kelly IV, MD, Associate Professor of Orthopedic Surgery, Vice Chairman, Department of Orthopedic Surgery, Temple University; Consulting Surgeon, Temple Children's Hospital and Shriner's Hospital for Surgery
John D Kelly IV, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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