Multiple Fractures
or
How To Break Two Ankles At Once
Imagine you want to take out the trash, and before you know it, you're lying on the floor, both ankles throbbing with pain and one foot doesn't look healthy at all, sticking out weirdly.
Sounds like it's made up?! Trust me, it isn't!
The ambulance called my surgeon in charge, as usual, and informed us that they were going to be in the ER in a few minutes with Patrick (name changed). He tells us to get the Fentanyl ready because the patient is in a lot of pain. When he told us that the patient seemed to have broken both of his ankles, we didn't believe it (sometimes ambulance staff can be a little hasty 😉).
I mean, come on?! How would you even do this?!
Who is Patrick, and how did that happen?
Patrick is a 45-year-old taxi driver. He went out to get rid of the trash lying around in the taxi central station. When he stepped out, he twisted his left ankle on a ledge and tried to catch himself with his other foot. Unfortunately, at that moment he twisted both feet extremely inwards, causing both ankles to break. His slight overweight did not contribute positively to the event either.
What do we do as ER-Staff in such a situation?
When the ambulance arrived, my surgeon colleague and I had a look at the feet and both knew, instantly, that this was not good ... not good at all. So after Patrick got an i.v. from us and some Fentanyl, we sent Patrick directly into the X-Ray Department where he got a CT-Scan of both ankles. It turned out that the right ankle was "just" broken, without dislocation, but the left ankle was massively dislocated (not that we didn't see that without CT already😉) and one blood vessel was ripped so he had a large haemorrhage into this foot. This explains, why it looked like a balloon, almost about to explode - poor Patrick! Luckily, the Fentanyl helped a little and Patrick dozed off a bit.
What happened next?!
Of course, Patrick needed urgent surgery to get this fixed. So we prepared him for the surgery and sent a Vacoped to the OR for the right foot.
Patrick had to undergo a major surgery for many hours to get both of his ankles fixed. After that, he lay in the hospital for a few weeks. He learned how to move around with the wheelchair and came for visits every once in a while. His whole treatment went on for a few months and we kept seeing him. Once he healed out, and got back to his job, he was our Go-To-Taxi-Driver when a patient needed a taxi and our relationship turned into a friendship.
Ankle Dislocations And Fractures
A summary of "Ankle fracture-dislocations: A review. Foot & Ankle Orthopaedics, 1–8. " written by Lawson, K. A., Ayala, A. E., Morin, M. L., Latt, L. D., & Wild, J. R. (2018)
Ankle Fracture-Dislocations Overview:
- Definition: A subset of ankle fractures involving dislocation of the tibiotalar joint due to persistent or high deforming forces disrupting bony or ligamentous stability.
- Distinct Features: Higher rates of complications like open fractures, chondral lesions, loose bodies, and worse long-term outcomes (chronic pain and post-traumatic osteoarthritis).
- Mechanism of Injury: Typically caused by rotational forces transmitted through the foot. Severity depends on the position of the foot and the direction of force.
True Dislocation Without Fracture:
- Extremely rare due to inherent joint stability.
- Typically results from high-energy trauma, such as sports or motor vehicle accidents.
- Often requires imaging (MRI/CT) for assessment, with treatments like ligament reconstruction yielding good outcomes.
Fracture-Dislocation of the Ankle:
- Involves severe damage to bones and soft tissues.
- Early treatment focuses on joint reduction, bone stabilization, and protecting soft tissues.
- Open reduction internal fixation (ORIF) is standard for displaced fractures, but outcomes vary, especially in older or diabetic patients.
- Long-term effects include worse functional outcomes, increased pain, and higher risk of arthrosis in open fractures.
Management and Treatment:
- Initial Steps: Immediate reduction is crucial to minimize neurovascular damage, prevent soft-tissue complications, and prepare for surgery.
- Imaging: Advanced imaging (CT/MRI) is often needed to identify associated injuries like osteochondral lesions (OCLs) and intra-articular loose bodies.
- Surgical Considerations: Techniques like open reduction internal fixation (ORIF) focus on restoring anatomy and managing concurrent injuries. External fixation may be used for cases with significant soft-tissue involvement.
Complications and Outcomes:
- Soft-Tissue Injuries: Increased incidence of open wounds and infections, particularly when timely reduction is delayed.
- Long-Term Impact: Higher rates of post-traumatic osteoarthritis, chronic pain, and delayed functional recovery compared to non-dislocated ankle fractures.
- Functional Recovery: Often delayed due to the complexity of associated injuries. Poor outcomes correlate with factors like malreduction and posterior malleolar involvement.
You want to know more about it? Check out this article!
You Need Help Writing A Blog?
As a former nurse and experienced medical writer, I know how to make complex health information clear and engaging. I create well-structured, patient-friendly content that informs and empowers.
Let me help your organization deliver messages that truly resonate.
