Ankle sprain / fibula fracture initial assessment / rehab

[jgg015]

hey, i am to do an initial examination on a patient who has just had a cast removed after 3 weeks following an inversion injury resulting in ankle sprain and fracture of fibula. I am just wondering if the fibula fracture should warrant altering any of my assessment or should i just continue as I would with just a lateral ankle sprain assessment? I was planning to assess both active and passive movements, muscle strength, and circumference to address swelling and atrophy. any thoughts on this or something else i should include ?

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[leebpt]

Hello,
You may or may not have complete your assessment yet and now I suspect you've done some reading around this type of injury,
if not then things you may want to consider are;
soft tissue healing
bone healing
type of # (weber classification)
mechanism of injury
Patients expectations
Patients goals
Motivation etc
They may of visited an orthopaedic surgeon and have a protocol to adhere too so you are right your initial assessment may change somewhat depending on what they present with once cast is off and they are in front of you.

good luck

[neurospast]

Yes it does definitely alter your assessment since you have to understand that a fracture of the Fibula can alter the movement pattern of the foot and the movement in the proximal and distal syndesmosis (joint) between fibula and Tibia with effects on the Dorsiflexion-plantar flexion of the foot and the external rotation of the knee.
In general a consultant will not give you a specific protocol since it is assumed a straight foreward rehabilitation after green light is given for full weight bearing.
What you need to know is pointed out by leebpt, as well as considering the grade of ligament tear which will be at least a grade 2 of ATFL, PTFL. Also these type of injuries can potentially obstruct the deep peroneal and Sural nerve as well as causing displacement of Tarsal bones (Especially Calcaneum, subtalar joint and Cuboid)
Hope this helps