Sprains are a pain

Friday, February 16, 2007

How many old wives’ tales do you deal with at work. Some patients say the darndest things and I am involved in a never ending struggle to avoid making snarky remarks.

The most recent had to do with a gymnast who missed a landing and sprained her ankle. She heard a loud pop, had almost immediate swelling on the outside of her ankle and was scared to weight bear. When I examined her, there was no bony tenderness over the maleoli, the bony protrusions at the ankle, there was no tenderness over the outside of her foot and she could walk gingerly in the ER.

In the theoretical world, this lady did not need an x-ray of her ankle. The Ottawa Rules (we’ll talk about the rules one of these days) predict that she would not have a broken ankle, but trying to convince an athlete and her parents of practical application was less than successful.

When she returned from X-ray, which was normal, we had this discussion:

Me: Good news. Just as we expected, the x-rays are normal and you don’t have a broken ankle; it’s sprained.

Her: I wish it was broken. I heard that it takes longer for sprains to heal and it’s better just to break it.

Me: I don’t think you that you want a broken ankle. They take many weeks to heal, sometimes need operations and casts are a pain in the butt to deal with. But just because it isn’t broken, doesn’t mean you don’t have a significant injury. You’ve torn the ligaments that hold your ankle together and it will take 4-6 weeks for it to heal completely.

Her: But when you sprain your ankle, they never heal right and they are always weak and I need my ankles for gymnastics. If it was broken, it would just heal.

Me: The same healing happens with a ligament tear as it does with a broken bone except that the body doesn’t lay down calcium at the injury site. If we get you to aggressive physical therapy, we can have you back in the gym relatively quickly, as good as new.

Her: I wish was it was broken.

Such a dilemma. Let’s recap.

Ankle Break: Initial cast, crutches, no weight bearing for a few days to get the swelling down. New form fitting fiberglass cast for 4-6 weeks and if all goes well, rehab to rebuild the muscles and return range of motion to the ankle and mid foot. This presumes that an operation isn’t needed to align the bones and stabilize the ankle joint.
Ankle Sprain: Ace, aircast, crutches, weight bearing as tolerated, physical therapy the next day, competition in a couple of weeks and enough rehab to make recovery complete for a total of a month.

I think I’ll take door number two.

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