The definitive test for a broken bone is an X-ray. There’s a fine line between a fracture and a sprain, so an X-ray is often the only way to tell the difference. Treatment of a broken ankle starts with an X-ray.
Bruising is another common sign of a broken ankle.
Bruising or discoloration is from blood. Usually, blood is contained in the blood vessels (arteries and veins). After an injury, blood leaks out of the blood vessels and pools in the flesh and muscle, where you can see it.
There’s one more sign commonly associated with broken bones: crepitus. This one is harder to imagine. It can’t be seen, but it can be felt. It’s the broken bits of bone grinding on each other with movement or manipulation of the injury. To the person feeling for it, it can be described as a bag of gravel. Not fun.
Deformity is a medical term for, well, being deformed. It’s when a part of the anatomy isn’t formed the way it’s supposed to be. It can be a bone that’s bent in the wrong place or a foot that’s twisted at an odd angle. It can also be as simple as a grossly swollen ankle.
Swelling is a really common form of deformity and it is from blood or other fluid accumulating at the site of the injury.
There are two types of clues as to whether a bone is broken or not. They’re called signs and symptoms. Symptoms are things only the patient can feel while signs are things anyone (patient or not) can see or touch. Basically, to stick with the sign terminology, these are things you can read.
The Only Symptom of a Broken Ankle
To get symptoms out of the way, you should know that a broken ankle has a specific pain.
The only sure-fire way to know if any bone is broken is by seeing the actual broken bone. That’s the sign, the one that clears up any doubt.
You definitely can see if a bone is broken by looking at it directly with the naked eye, but there’s usually a bunch of pesky flesh and blood in the way. Usually, you need to use an X-ray to see a broken bone.1
Of course, when the broken ends of a femur are sticking out of your thigh, it’s pretty much a dead giveaway. Barring either a really nasty compound fracture—or a creepy zombie style cutaway just to get a look—you’ll need that X-ray.
At the end, I’ll show you what a broken ankle can look like on an X-ray (albeit, in this case, with a really tiny fracture). For now, let’s concentrate on the signs of a broken ankle we usually can see, and we’ll start with deformity.
Once the ankle has been immobilized with the pillow, re-assess the function of the foot below the injured ankle. Note any differences between the first and second assessments.
A pillow splint will provide enough support for an injured ankle to get the patient to medical care. A pillow splint is not a long-term solution. This is just enough to get to a healthcare professional.
You can still ice an injured ankle once it has been splinted. Just be sure to put the ice pack over the pillow, not under it. Believe it or not, you can easily cause frostbite with an ice pack.
Wrap the pillow around the ankle. Tape above and below the ankle injury. Take care not to wrap the tape too tight. Almost any strong tape can be used. Duct tape was used here.
Put the pillow under the injured ankle. Make sure the pillow reaches from the lower leg to the foot. It’s important to immobilize the bones above and below the injury.
Assessing the ankle includes assessing the function of the foot below the ankle. There are three main points to assess.
- Circulation: Assess circulation by feeling the temperature of the foot. Compare the temperature of the injured foot to the temperature of the uninjured foot. You can also assess circulation by feeling for the presence of a pulse in the foot or by checking capillary refill. Note any difference in temperature between the patient’s two feet.
- Sensation: Assess the sensation of the foot by touching a toe and asking the patient to identify which toe is being touched. Note any numbness or tingling the patient feels when his or her injured foot is touched.
- Motion: Have the patient wiggle the toes on the injured foot. Note any inability of the patient to move the toes or foot.
Ankle injuries are common and they can be very painful. Twist an ankle at home and you probably don’t want to call an ambulance since it’s not life-threatening. On the other hand, you also don’t want to cause more damage by accidentally putting pressure on your injured ankle en route to the doctor’s office, clinic, or emergency department.
The solution? Use a pillow and some tape to splint the ankle. It’s the easiest way to make a splint at home using things you probably have lying around. Pillows aren’t tough enough for long leg fractures like the tibia or the femur, but they will provide enough support for an injured ankle.
The American Heart Association says we have to stop saying ABC and start using CAB. That’s silly. Here’s a way to remember the steps for treating a patient using ABC.
Before You Start
Professional rescuers practice universal precautions when providing medical care to victims. Universal precautions are steps used to reduce the potential for victims to infect rescuers. Practicing universal precautions requires personal protective equipment, such as gloves or eye protection.
To better protect yourself, you should make sure your first aid kit is adequately stocked with the personal protective equipment necessary to practice universal precautions.
Safety is an ongoing concern that must never leave your thoughts.
There is a primal instinct in many people to dash to the rescue of those in need. Regardless of the dire circumstances of whatever terrible accident or injury you may witness, it’s urgent that you keep your wits about you and stay safe.
Safety is an awareness of your surroundings and a healthy fear of unstable situations. By its very nature, an emergency is an unstable situation. If everything were truly under control, nothing bad would’ve happened in the first place.
If, for example, you see a person struck by a car in a crosswalk, do not rush headlong into the street to see if they’re injured. You will no doubt find yourself lying next to them after being struck by the next car barreling down the road.
In its 2010 CPR Guidelines, the American Heart Association changed the order of ABCs. ABC is still the best way to remember the beginning, so here is a new way to think of the ABCs and still follow the CPR Guidelines:
- A: Awake?
- B: Breathing?
- C: Continue Care
A is for Awake. Is the victim awake, yes or no?
If the victim is not awake, try to wake him. Give him a brisk shake of the shoulders or rub your knuckles on his breastbone and shout something. Anything will work. Try “Hey you!” or “Yo, dude!” or “Go Giants!” It doesn’t matter what you say, as long as you say it nice and loud to give him a chance to wake up.
Not waking up? Make sure someone is calling 911 (if no one else is there to help, then you should call 911 before you do anything else). Now, move on to B: Breathing.
If she is awake, talk to her. If the victim can’t talk, is she choking? If she is choking, do the Heimlich maneuver.
If the victim wants an ambulance or wants to go to the hospital, make the call. If she’s talking but not making sense and she’s confused, call 911 immediately and start thinking about why she might be confused.2
B is for Breathing. If your victim is not breathing, start CPR. Remember to tell someone to call 911 if you haven’t already.
Start CPR by pushing on the middle of the chest, right between the nipples. Push hard and fast, at least 2 inches deep and at least 100 times per minute (sing “Stayin’ Alive” or “Another One Bites the Dust” in your head and push with the beat).
If you’ve never taken a CPR class or you don’t remember all the steps that well then just keep pushing fast and hard until somebody shows up to help.
If you feel comfortable with CPR, then follow the steps: 30 chest compressions, followed by two rescue breaths, and repeat.
But the Victim Is Breathing!
Think your victim is breathing? Take another look. Is he gasping for air kind of slowly, like a fish out of water? If so, start CPR just like if he wasn’t breathing (learn how to do CPR on gasping victims).
So you’ve decided that your victim is breathing fairly normally. Someone called 911 when you realized your victim wasn’t waking up (nobody’s calling 911? Call now).
Take a breath (your victim is, so you can) and move on to C: Continue Care.
C: Continue Care
C is to Continue Care. You have a victim who won’t wake up (unconscious) but is breathing. 911 has been called and an ambulance is on the way. If the 911 operator tells you what to do, follow the operator’s instructions and stop reading this.
If you’re on your own, here are some tips to follow until the ambulance gets there:
- If the victim is face down and unconscious, roll her on her back, face up.
- If the victim has fluid, blood, vomit or food in his mouth, roll him on his side with his arm under his head.
- Stop any bleeding by putting pressure on the wound.
- If the victim stops breathing, start CPR.
- Gather the victim’s medications if available and lock up any dogs they may have.
Some conditions have special considerations:
- Low blood sugar
- Shortness of breath
When the Ambulance Isn’t Coming
The ABCs up to this point assume that an ambulance is on the way or the hospital is not far. Sometimes, however, you’re on your own for much longer. If that’s the case, now’s the time to treat simple injuries.
Injuries that need immediate care:
- Bee stings
- Head Injuries
- Snake bites
Exposure injuries (too hot or too cold) that need immediate treatment:
- Heat illness (heat exhaustion and heat stroke)
Injuries that can wait, unless you absolutely have to treat them:
- Frostbite (do not thaw unless no chance of being frozen again)
- Broken bones (only splint if you have to move the victim)
Dress wounds as needed (focus on the big stuff; little things can wait).