An ankle fracture at the level of the malleolus is very painful. It requires immobilization or even surgery and rehabilitation sessions. What are the symptoms ? How long for healing?
The term malleolus refers to one of the two bony tuberosities located at the level of theankle joint. A distinction is made between the medial (or tibial) malleolus, which is a normal outgrowth of the lower part of the tibia, and the lateral (or fibular) malleolus, which is part of the fibula (ex-fibula). The fracture of the malleolus is usually caused by local trauma following a fall or a blow. What are the symptoms ? How to establish the diagnostic ? How to cure a fracture of the malleolus? What re-education ? How quickly can you walk again?
What is a malleolus fracture?
“The most frequent ankle fracture is the isolated fracture of the fibular malleolus due to a rotational movement: the body goes inwards, while the foot remains immobile”, explains Dr. Christophe Cermolacce, orthopedic surgeon. Trauma can break the medial or lateral malleolus, or more rarely both at the same time. In cases of fracture, it is important to know whether the ligament called syndesmosis (which allows in particular to maintain the malleolar clamp) is torn or not. As a result, fractures are classified according to the probability of a rupture of this ligament:
- Weber A type fracture : fracture below the syndesmosis; the joint is still mobile.
- Weber B type fracture : fracture at the height of the syndesmosis; often the ligament is affected due to rotational movement but the joint may still be mobile.
- Weber C-type fracture : fracture above the syndesmosis; the ligament is torn due to a lateral translational movement.
What are the causes of a malleolus fracture?
Ankle fractures mostly occur during twisting movements after slipping or tripping. For example, when:
- of one poor landing of a jump ;
- of one ankle twist in women wearing high heels ;
- or a direct hit worn during a team sport match (rugby in particular)
“More rarely it is a stress fracture, without causal trauma. It can occur in a person in overweight or during excessive training”, says our interlocutor.
What are the symptoms of a malleolus fracture?
The main symptoms of this injury are:
- A impotence functional. We don’t set foot!
- A pain spontaneous and pressure on the affected malleolus
- A reduced mobility and painful
- A swelling growing in the ankle area
- A swelling and sometimes a blood effusion at the ankle
- A malposition of the foot in relation to the leg, due to a dislocation of the ankle.
After examining the foot and surrounding joints, the doctor (general practitioner, emergency doctor or orthopedic surgeon) will prescribe 20 degree frontal ankle x-rays internal rotation and profile. “We must also plan whole leg x-rays since the fibula can be fractured relatively high, as in the case in particular of Maisonneuve’s fracture”, adds the specialist. In complex fractures, CT scan may be requested for better indication and preparation for surgery.
The resumption of sport will only be possible once the ankle is consolidated
If the fracture is not displaced (Weber A or B), the standard treatment is to immobilize the leg (removable or plaster) for 6 weeks. Of the painkillers can be prescribed for pain. In contrast, fractures involving tearing of the syndesmosis (Weber C) or instability of the joint require surgical intervention. The management of ankle fractures makes it possible, on the one hand, to reduce the fracture in the event of a fracture with displacement of the bone components. It’s about putting back in place and align the different bone pieces who moved. On the other hand, maintaining this reduction by implementing metal surgical equipment (screw, plate, nail, etc.), in order to keep the various bone components in place. “After the procedure, the leg should first be partially rested, usually in a bootinsists the doctor. Mobilization may be earlier than with orthopedic treatment, but it takes more than 8 weeks to be able to re-stress the ankle Normally.”
What is the healing time for a malleolus fracture?
Support is generally 60 to 90 days in the absence of complications, this period may vary depending on the type of fracture and intervention. Following the treatment of an ankle, it will be necessary to follow sessions of physiotherapy rehabilitation to strengthen the ankle. The resumption of sport will only be possible once the ankle is consolidated (often more than 3 months). “The edema often persists for more than 4 months, concludes Dr. Cermolacce. The osteosynthesis material is removed at the end of the first year. And the ankle is totally healed after 1 year.”
Thanks to Dr Christophe Cermolacce, orthopedic surgeon at Clinique Blomet (Paris 15th).