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0 - ArchivalUser - 10-28-2007
Ankle Sprains
Ankle sprains are among the most common of all sports injuries. Most sprains involve the lateral ligament complex, particularly the anterior talofibular ligament. In more severe injuries, the calcaneofibular ligament may also be involved. If both of these ligaments are ruptured, the injury results in significant joint instability and is classified as a grade III (severe) sprain. (Grades I and II correspond to mild and moderate injuries, respectively.) This section reviews only the type of ankle sprain resulting from inversion (varus) injuries, which account for 85% of all sprains.
Clinical Findings
Varus sprains include a spectrum of severity, ranging from slight loss of function to injuries in which the swelling is prompt, the pain prominent, and weight bearing impossible. A history of hearing a œpop at the time of injury is frequently associated with the latter.
Hemorrhage resulting from torn ligaments and damaged peroneal muscle tendons may cause substantial ecchymosis. Tenderness is typically present at the site of injury, and the associated swelling may be considerable. Stability of the anterior talofibular and calcaneofibular ligaments should be assessed with the œanterior drawer sign: With the foot held in slight plantar flexion, the examiner cups the patient's heel with one hand and the patient's shin with the other. The examiner then applies gentle anterior force in the plane of the patient's foot. Excessive anterior motion of the foot constitutes a positive test (grade III sprain). Plain radiographs exclude associated bony injury.
Treatment
Most ankle sprains”even grade III”are treated identically. The acronym œRICE (rest, ice, compression, elevation) applies more accurately to ankle sprains than to any other injury. Early application of a compression dressing is essential to control swelling and provide stability to the traumatized joint. An Air cast ankle brace is more effective than an elastic compression bandage. Weight bearing should be minimal, with liberal use of crutches. Elevation of the ankle for several days hastens functional recovery by diminishing pain and swelling, and ice is also helpful (alternating 30 minutes on, 30 minutes off). The ice should be applied on top of the compression dressing and not against the skin both because close apposition of the dressing to the skin is critical to control swelling and because direct application of ice is uncomfortable and even deleterious to the skin. Referral to a physical therapist may expedite recovery. Patients should be informed that symptoms from lateral ankle sprains may take weeks or months to resolve, and that this period will be prolonged by premature attempts to bear weight on the injured ankle. Surgical repairs of ruptured lateral ligaments provide excellent outcomes but are usually necessary only in cases of chronically unstable joints.