Ankle Injury In A Hockey Player

HISTORY: A 23-year-old professional ice hockey player sustained a collision during competition. He fell onto the ice as he was hit by an opponent into the rink dasher boards. Mechanism of injury involved inversion of the skate on the left foot and ankle. The player experienced sudden onset, severe left foot, ankle, and calf pain. He was unable to bear weight on the distal left leg due to significant pain. He was subsequently taken to the ER for further evaluation. PHYSICAL EXAMINATION: Left ankle deformity, swelling, and ecchymosis Tenderness over the left distal fibula Negative tenderness over the left medial malleolus Ability to dorsiflex to neutral position Limited plantarflexion Ankle eversion and inversion guarded Distal neurovascular exam intact DIFFERENTIAL DIAGNOSIS: 1. Left distal fibula + tibia fracture 2. High grade left ankle sprain 3. Left ankle tendon rupture 4. Left ankle dislocation TEST AND RESULTS: X-ray Left Ankle: Acute oblique, spiral fracture of the distal fibula with ~3 mm of maximal offset of the fractured segments. FINAL WORKING DIAGNOSIS: Left comminuted, nondisplaced distal oblique, spiral fibular fracture with syndesmotic diastasis, with no apparent deltoid injury. TREATMENT AND OUTCOME: The patient was initially managed with a splint and anti-inflammatories. Day 7, the patient underwent an ORIF of the left distal fibula with repair of the syndesmotic diastasis. The procedure involved a fibular intramedullary nail with proximal and distal fixation with dual knotless tight rope implants, placed through percutaneous minimally invasive incisions. The repair centered around a dynamic stabilization procedure, restoration of the mortise, with hardware to remain in place. The goal of this technique is to allow for accelerated wound healing and rehabilitation, while limiting hardware irritation adjacent to any equipment worn. The patient completed rehabilitation and was cleared to skate 3 months post-operation. He returned to play at 3.5 months.