The news of Bo Nix’s injury was a shock to many simply because he walked off the field after the win. How does severity vary in ankle fractures, and does being able to walk lend any insight into an injury?
Watching the game, certainly it was a surprise to learn of the extent of the injury, given that Bo was seen standing for interviews and walking off the field. That said, professional athletes like Bo Nix tend to be incredibly tough and resilient, and that, combined with the adrenaline after such a big win, may mask the pain a bit.
There is a wide variety of severity with ankle fractures, ranging from small fractures that are considered stable and often don’t require surgery, to displaced — where bone fragments are far apart from where they should be — and/or comminuted, where there are many different bone fragments. There are also open fractures, bone breaks through the skin, and ankle fracture-dislocations. There are different bones that can be involved, including the fibula, the tibia, the talus, and other bones throughout the foot, which speaks to the complexity of the ankle joint. There are also ankle fractures that can occur alongside ligament and/or cartilage damage.
Are ankle fractures difficult to diagnose?
We usually diagnose ankle fractures using X-rays, combined with the athlete’s history, injury mechanism, and physical examination. In the acute, or fresh, setting, such as with Bo Nix’s injury, the X-rays are likely to be the most helpful diagnostic tool. These injuries are not typically difficult to diagnose once all the relevant information is available.
We know that Nix is receiving surgery for his injury. Are surgical treatments common for ankle fractures? What’s typically involved in those kind of procedures?
While some ankle fractures are considered stable and do not require surgery, many ankle fractures unfortunately do require surgery. The type of surgical treatment depends on the type of fracture and the extent of any associated injuries, such as ligament and/or cartilage injuries. Usually, unstable fractures will require surgical fixation with implants such as metal plates and screws.
There are other fixation techniques, including those that utilize suspensory fixation devices with buttons, as well as other techniques, such as arthroscopy, that can also be used for ankle fracture fixation, but again, this all depends on the fracture pattern and associated injuries.
A lot of the general public thinks of fractures as being something different from a full break. Are they the same things?
This is a very common question, and the language describing these injuries can sometimes be confusing. The word “fracture” indicates that a bone is broken (ie, a full break). There is no functional or meaningful difference between describing this type of injury as a fracture versus a break versus a full break.
What does recovery timing usually look like for ankle fractures?
The recovery timeline can vary and typically depends on the extent of the injury itself, the stability of the fixation, and the damage — if present — to the soft tissues including the ligaments/cartilage. Any pre-existing injuries to the same ankle can also impact recovery. Typically, fractures heal in eight to 10 weeks, and it takes several more weeks to months to get the soft tissues to heal, and the fitness/endurance/strength to come back to an acceptable level.
Do ankle fractures present risk factors for further injury?
Great question. Certain types of ankle fractures may put the patient at risk for future problems, such as arthritis, in the same ankle. With respect to further injury, if the fracture is diagnosed correctly, treated correctly, and rehabbed correctly, as long as the bone and soft tissues heal appropriately, we would expect an athlete to be able to get back to their sport without significant additional risk for further injury. If the athlete comes back too fast, meaning, before the bone and soft tissues have had a chance to sufficiently heal, or is not appropriately rehabilitated, re-injury risk is higher.
Photo credit: wikicommons/VCcortex
