Detroit Tigers’ Magglio Ordonez Suffers an Ankle Fracture
In the third inning of Saturday night’s game against the Toronto Blue Jays, Detroit Tigers’ right fielder broke his ankle while sliding into home plate. He was immediately taken out of the game. Will Ordonez be back this season?
The ankle is made up of three bones: the fibula (on the outer part of the ankle), the tibia (on the inner part of the ankle), and the talus (on the central part of the ankle). Between the tibia and fibula, at the level of the ankle joint, is a ligament which holds these one together, called the syndesmosis.
Any of these structures can be injured in an ankle fracture/break. Typically, the fibula is fractured. At the same time, the tibia can be broken and/or the syndesmosis can be torn.
The ankle can break with any type of trauma that causes excessive energy to go through the ankle. The energy can break 1, 2, or more bones. Typically, the ankle breaks with a twisting mechanism, when the ankle “rolls”, or if one trips and falls. Occasionally, a direct blow to the ankle or the heel can break the ankle.
A person who breaks their ankle usually experiences immediate pain and swelling. A pop or crack may be heard or felt. The ankle will get black and blue. Often times, the person will not be able to walk on the broken ankle.
WHEN TO SEEK MEDICAL CARE
If you suspect that you have an ankle fracture, you should seek medical attention within hours of the injury. A thorough physical exam and xrays will be needed to find out if you have an ankle fracture and the type of fracture you may have.
Treatment varies depending on the severity of the ankle fracture. If the fibula has broken, but has not shifted, a non-weight bearing cast may be worn for 8-10 weeks. If the fibula is fractured and shifted out of place or the tibia is fractured or the syndesmosis is torn, then surgery may be necessary. In the operating room, an orthopaedic surgeon will usually place a plate and screws in the fibula, screws or a plate in the medial malleolus part of the tibia, and/or screws or a similar device across the syndesmosis. This allows for the broken bones and ligament to be held in place while the bones and/or ligament heals. If the syndesmosis is torn, the patient is not allowed to put weight on the foot and ankle for 3 months. If the syndesmosis is not torn, then the patient is not allowed to put weight on the foot and ankle for approximately 6-10 weeks.
Below are representations of a type of ankle fracture where the fibula and the syndesmosis were torn and needed to be repaired.
Most patients with ankle fractures are able to return to their pre-injury activities with little or no difficulties. However, there are some long-term implications of this injury. First, about 30% of the time a “pot-hole” can develop in the ankle at the time of the injury. This can lead to long-term pain. Second, the cartilage is damaged at the time of injury. This causes the development of post-traumatic arthritis in the ankle at a faster rate than an ankle that has never been broken. Third, many patients will have stiffness and loss of motion following the injury. Finally, extensive physical therapy is required to regain as much motion and strength in the ankle.
RETURN TO ACTIVITIES
Depending on the type of ankle fracture that Ordonez has, he will be out of baseball for at least 8 weeks. If his syndesmosis is also torn, he will be out for 12 weeks.
For a video animation of “Ankle Fracture Surgery”, please see the “Education” tab of my website. Click orthopaedics, then foot and ankle, then procedures, then Ankle Fracture Surgery.
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