Sprains, fractures and instability
Sprains and fractures are common types of orthopedic injuries. Most everyone knows what a bone fracture is—a breakage of a bone. Fractures can range from small cracks to total separation of two or more pieces of the bone, or even one or more shattered bones. There are many types of fractures that your foot and ankle specialist can treat and repair, with surgical intervention if necessary.
Sprains are not as well understood by most people as fractures are. An ankle sprain is a very common injury. It accounts for about % of athletic injuries. So what exactly happens when we sprain our ankle, for example? There are ligaments that help support our ankles when we walk, jump, run, etc., especially on uneven ground. When we “twist” our ankles these ligaments are stretched beyond their capability to do so. Sometimes they are stretched (mild sprain), partially torn (moderate sprain) or fully torn (severe sprain).
Most sprains—mainly the mild type—heal uneventfully with an initial period of rest, ice, compression, and elevation (RICE). However there are many that do not fully heal, where the ligaments stay “loose.” Common symptoms are continued feelings of instability, pain and swelling. A common complaint in the case of an ankle sprain is “my ankle feels weak.”
So how do we treat ankle sprains? In addition to RICE, one may try a brace or even a cast for a few weeks depending on how severe the sprain. After this initial period of immobilization, a physical therapy program is started. The purpose of physical therapy is to prevent recurrence of the injury or chronic instability of the joint. Therapy helps to strengthen the joint and “retrain” it to keep itself stable.
Sometimes there are patients who despite physical therapy have continued problems of pain and instability. In these cases surgery may be indicated. Surgery entails taking the torn ligaments and “tightening” them up again. For most patients this is an outpatient procedure. Postoperatively, I treat my patients in a cast for six weeks followed by a 4 to 6-week course of physical therapy. Expect a return to normal activity in four to six months post operatively.
Bone fractures are common in active children, particularly those engaged in sports activities. Adults can also have serious fractures that can be disabling and result in long treatment and recovery times. In the past, treatment for fractures such as a broken thighbone (femur) would be a long and difficult process involving a possible hospital stay, traction and months in a cast. Today we have better techniques for treating serious fractures that may shorten the recovery time, hospital stay, and need for a cast. These treatments may require surgery, and therefore need careful consideration and consultation with an orthopedic surgeon who can offer these options.
Most often, the final decision depends on a quality-of-life consideration between you and your doctor. In the case of children, the child's age also affects treatment decisions. A broken thighbone that heals in three months in a teenager would heal in only three to four weeks in a preschooler. Orthopedists generally divide children's fractures into three categories:
- Those that heal well only with surgery. For example, a child would probably need surgery to successfully treat a broken hip, growth plate or joint surface.
- Those that heal equally well with surgery or with immobilization. For example, a child may or may not need surgery to treat a broken thighbone.
- Those for which surgery is not usually necessary. For example, a child would probably not need surgery to treat a broken forearm.
Most children's fractures can be treated without surgery. But in the group of fractures that can be treated either way, we can help you choose the option that is best for your situation and quality of life considerations.