An avulsion fracture occurs when a tendon or ligament attached to a bone pulls against it and fractures off a piece of the bone.
Most often, this occurs during sudden movements and changes in direction. Though more common in children, athletic adults are also prone to avulsion fractures. This type of fracture can happen anywhere a tendon or ligament is attached to a bone, but they typically affect ankles, hips, fingers, and feet.
In this article, we will cover what an avulsion fracture is, what causes it, how to identify if you have an avulsion fracture, and the recovery process.
By definition, an avulsion fracture is a noun that is also known as a ‘sprain fracture.’ It is a detachment of a bone fragment that occurs when a ligament, tendon, or joint capsule pulls away from its point of attachment.(1)
With an avulsion fracture injury, a fragment of bone breaks away. This occurs at the site where a tendon or ligament attaches to bone and happens because the tendon/ligament abruptly pulls on the bone, breaking a piece of the bone away.(2)
Unlike stress fractures that occur slowly due to repetitive movement, an avulsion fracture is the result of a sudden movement. Growing children are at risk of avulsion fractures. As they grow, their ligaments and tendons may pull excessively against the bones they are attached to. This compromised muscular-skeletal structure can be problematic when growing children participate in sports, leaving them susceptible to avulsion fractures.
Though a more common injury in children, athletic adults may also experience avulsion fractures when their tendons are able to bear more load than their bones. Avulsion fracture injuries usually occur during high-impact sports that include twisting movements and quick changes of directions. Likewise, dancers are at risk of this type of injury due to their movement patterns.
Avulsion fractures of the ankle are commonly caused by the twisting of the ankle and typically affect the medial malleolus bone. This bone runs along the inner side of the ankle at the lower end of the tibia.(3)
You may be wondering, “are avulsion fractures painful?”
The answer is yes.
Typically, symptoms of an avulsion fracture of the ankle are felt from the moment the trauma occurs. Because the injury is likely the result of a twisting movement, avulsion fracture ankle pain may present similarly to an ankle sprain. (4) In both types of injuries, common symptoms include:
To distinguish between an avulsion fracture and an ankle sprain, your doctor will first perform a physical examination of your ankle. After determining if you can bend and straighten the joint, your doctor may decide X-rays are needed. With an X-ray, your doctor will be able to see if you’ve fractured a bone. Sometimes your doctor may even discover an old avulsion injury that went undiagnosed.
It’s important to ask for x-rays if you are concerned you may have an avulsion fracture. Misdiagnosis of this injury can lead to permanent nerve damage, as well as long term difficulty with walking and running. If you have an avulsion fracture of the ankle, proper treatment is necessary for a full recovery.
Rest is essential to proper avulsion fracture ankle treatment.
Ice for 10 minutes on/ 10 minutes off will help reduce swelling when the injury first occurs. However, it’s important to be aware of how long you are icing the injury. Longer than 10-15 minutes at a time can be problematic and may cause additional swelling as the body tries to prevent hypothermia. Thus, apply ice in short spurts, always protecting your skin by placing a protective barrier like a cloth between yourself and the ice.
Compression helps to prevent further swelling and to stabilize the injury. When the avulsion fracture injury occurs, immediately wrap your ankle with a compression wrap or elastic bandage. This will also help to minimize pain as it will hold your ankle in place and limit movement.
when the injury first occurs is useful. Since you’ll be off your feet anyway, use the time to lie on your back, propping your injured ankle up on a stack of pillows. Keeping your injured ankle above your heart will help drain excess blood from the site of the injury to reduce swelling as you recover.
Limiting the movement of your ankle as it recovers is essential.
An ankle brace for an avulsion fracture may help with this, but your doctor will likely prescribe the use of a boot. This will protect the ankle and keep it stable so it can heal properly. With children, casts may be used in place of a boot if the avulsion fracture is severe. (6)In addition, most avulsion fractures of the ankle will require you to be non-weight bearing during your recovery.
It is important to remain non-weight bearing as the injury heals. Traditional crutches are regularly used by individuals with lower leg injuries, including avulsion fractures of the ankle, but they may not be the most effective mobility aid for this injury.
The most common complaint involves pain in the hands and underarm area. Additionally, because it is difficult to perform activities that require the use of your hands when using traditional crutches, people often momentarily bear weight on their injured leg. This can easily cause re-injury or prolonged healing time as pressure on the bone will interfere with healing.
Knee walkers or knee scooters, as they are commonly referred to, are popular because they eliminate the pain and soreness aspect of traditional crutches. .
To use a knee scooter, you’ll bend your injured leg 90 degrees at the knee and kneel on a platform. That platform is attached to a frame with four wheels and handlebars are used for steering purposes.
This mobility aid is often preferred over traditional crutches. However, there are still disadvantages to a knee scooter. Both hands are needed to control the device which can be restrictive. Also, the device is bulky, which can become an issue when getting in and out of a car. Finally, the turning radius is limiting in tight spaces, and it can not be used on stairs or uneven terrain.
The hands-free and pain-free, iWALK2.0 is another alternative to traditional crutches.
Similar to the knee scooter, the user kneels on a platform. However, it is significantly different in that instead of using wheels below the platform, the iWALK2.0 has a strut connected to a simple prosthetic foot with a rocker bottom to facilitate walking. Some describe it as a high tech pirate leg. The user’s leg is strapped into the device, making the strut and foot an extension of the user’s leg. With the iWALK 2.0, the hands are free while walking and standing.
Clinical trials have also revealed that people with lower leg injuries using a hands-free crutch have healed faster than with conventional crutches. And retaining one’s mobility and independence through the use of the iWALK 2.0 crutch is a significant benefit.
Most often, avulsion fractures do not require surgery. Usually, stabilizing the ankle and remaining non-weight bearing as it heals will be enough for a full recovery. However, in rare cases, surgery may be a necessity. This happens when the bone fracture has pulled too far from the bone for it to fuse back to the bone naturally. (7)
Depending on the severity of the fracture, your doctor may order between three and 12 weeks of healing time for your avulsion fracture ankle injury.
Most often, those with boots or casts will need to wear one for six to eight weeks.(8) If surgery is involved, recovery may take a bit longer.
When the cast or boot is removed, a period of rehabilitation is required. Often a physical therapist will help you to strengthen your injured ankle with an exercise regimen. Rehabilitation will include retraining your walking gait, relearning to balance on the injured leg, and bringing flexibility back to the muscles and tendons surrounding your ankle. This rehabilitation is necessary as it will help to prevent re-injury of the area.(9)
You may be asking, “What is the fastest way to heal an avulsion fracture?”
Unfortunately, there is no shortcut to healing. Your body will need time to repair the injury and attempting to rush your recovery will only result in prolonging it. The best thing you can do during this period of recovery is to follow your doctor’s orders, utilize the R.I.C.E method, and remain non-weight bearing with the use of crutches or the iWALK 2.0
Sometimes overlooked or misdiagnosed as an ankle sprain, it is important to ask for an x-ray if you suspect you may have an avulsion fracture of the ankle.
With this type of injury, rest is vital to recovery and healing will require that you remain non-weight bearing for a specified period. A severe avulsion fracture may require surgery, but this is not typical. More often, your doctor will prescribe the use of a walking boot or cast to stabilize your ankle along with a mobility device. When you are ready, physical therapy may be utilized to strengthen the site of the injury.
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