6 Clues Your Ankle is Broken, Not Sprained
by James Hubbard, MD, MPH
Sometimes it’s not that easy to tell a sprain from a broken ankle.
Just this past year, a seventyish-year-old woman came limping into the clinic where I was working to have her ankle checked. Seemed she had twisted it a couple of weeks before and her husband was going to keep nagging her until she came in.
The X-rays revealed a break. A pretty bad one at that. She couldn’t believe it. I don’t know if she was more upset that she was going to need a cast and crutches or she’d have to acknowledge that her husband was right.
Many people come to the clinic convinced they have a break or just as sure it’s just a sprain. Often they end up being wrong. It’s not so easy for doctors to tell either. Fortunately we have the benefit of X-rays. But what if getting an X-ray is impossible? What can tip you off that it’s a sprain or a broken ankle? And why does it matter?
Well, why it matters is easy. If it’s broken, you must be much more careful to stabilize the ankle. Make it so the ankle won’t move. And if it’s any break other than the fibula (the littler of the two leg bones), then you shouldn’t bear a lot of weight on it because, again, the bone fragments could move around, not allowing healing.
The Ottawa Ankle RulesYears ago, some docs in Canada, trying to cut down on the amount of X-rays done for ankles (Canada must not have as many malpractice suits as we do in the U.S.), came up with a set of guidelines to tell a break from a sprain. It’s called the Ottawa Ankle Rules. The rules aren’t perfect, but many studies since have shown over and over that these guidelines can reliably predict about 95 percent of breaks. They do, however, tend to overdiagnose (predict a fracture that turns out to be a sprain).
The bad news is that studies have also shown that if nonmedical people try to use the guidelines and make predictions they’re not nearly as accurate. So don’t use these to keep from getting your injured ankle checked out when a clinic actually is available. But maybe they can help a little if there ever comes a time when you can’t get expert medical help right away.
Next, the rules.