Broken Ankle: A Guide for Nursing Students
Introduction
A broken ankle, or ankle fracture, involves one or more of the bones in the ankle joint—the tibia, fibula, and talus. Ankle fractures are common injuries, often resulting from falls, sports accidents, or twisting injuries. Nursing students should understand the basics of ankle fractures, diagnostic methods, treatment options, and nursing care to effectively assist in managing patients with this condition.
Types of Ankle Fractures
Ankle fractures are classified based on the number and location of the bones involved:
1. Lateral Malleolus Fracture: Involves the fibula on the outer side of the ankle.
2. Medial Malleolus Fracture: Involves the tibia on the inner side of the ankle.
3. Bimalleolar Fracture: Involves both the lateral and medial malleoli, resulting in a more unstable injury.
4. Trimalleolar Fracture: Involves the lateral malleolus, medial malleolus, and the posterior aspect of the tibia, often resulting in a very unstable ankle (Cakir et al., 2015).
Diagnosis
Diagnosis of an ankle fracture typically includes:
• Physical Examination: Swelling, bruising, and tenderness over the ankle joint can indicate a fracture.
• Imaging Studies: X-rays are the primary diagnostic tool, as they provide detailed images of bone alignment and fracture location. In complex fractures, CT scans or MRIs may be ordered to assess the extent of damage to soft tissues and bone fragments (Michelson, 2015).
Treatment Options
The treatment approach for a broken ankle depends on the type and severity of the fracture:
1. Non-Surgical Treatment: Stable fractures may be managed with immobilization, such as a cast or brace, allowing the bones to heal over time.
2. Surgical Treatment: Severe fractures, particularly those that are unstable or involve joint misalignment, often require surgery. This may involve open reduction and internal fixation (ORIF), in which plates, screws, or rods are used to stabilize the bones (Michelson, 2015).
Nursing Care and Interventions
Nursing care for patients with a broken ankle focuses on pain management, mobility support, and preventing complications. Key nursing interventions include:
• Pain Management: Administer prescribed analgesics as needed, and educate patients on elevating the affected leg and applying ice to reduce pain and swelling.
• Immobilization and Skin Care: For patients with a cast, monitor for signs of compromised circulation or skin breakdown. Assess capillary refill, sensation, and movement distal to the cast regularly.
• Education on Mobility and Safety: Provide instructions on using crutches or walkers if non-weight-bearing status is required, and educate on safe techniques to avoid falls.
• Complication Monitoring: Monitor for signs of complications, such as deep vein thrombosis (DVT), infection at the surgical site, or compartment syndrome, which may present as increased pain, numbness, or swelling beyond what is expected (Cakir et al., 2015).
Patient Education and Discharge Instructions
Upon discharge, patients should receive instructions on:
• Proper Elevation and Rest: Advise patients to elevate the ankle above heart level to reduce swelling.
• Activity Limitations: Educate patients to avoid weight-bearing activities until cleared by the healthcare provider.
• Warning Signs: Teach patients to monitor for signs of infection, excessive swelling, or changes in skin color, and to seek immediate care if these occur.
Conclusion
Understanding the basics of ankle fractures and providing effective nursing care can help promote healing and prevent complications. Through pain management, mobility support, and patient education, nursing students play an important role in the recovery process for patients with broken ankles.
References
Cakir, H., Van Vliet-Koppert, S. T., Van Lieshout, E. M., De Vries, M. R., & Van Der Elst, M. (2015). Complications following treatment of ankle fractures: a systematic review of the literature. Journal of Foot and Ankle Surgery, 54(4), 646-651.
Michelson, J. D. (2015). Ankle fractures resulting from rotational injuries. Journal of the American Academy of Orthopaedic Surgeons, 14(10), 604-613.