A Pott's fracture is a fracture to one of the bony parts of the ankle called the malleoli. Fractures can occur to the lateral malleoli on the outside or the medial malleoli on the inside. It can be difficult to separate this ankle injury from a sprain, though feeling the ankle with the hands can sometimes indicate if it is a fracture or not. An x-ray can show for sure if it is a fracture.
Symptoms of Pott's fracture
A Pott's fracture occurs in the same way an ankle sprain might happen. Therefore it is often difficult to distinguish between a Pott's fracture and an ankle sprain in the early stages of injury. Symptoms will typically include instant severe pain. The athlete will be unable to put weight on the leg and there will be tenderness at the point of fracture. There will be considerable swelling and bruising.
What is a Pott's fracture?
A fracture to the lateral, medial or posterior malleoli or bony parts on the outside and inside of the ankle respectively is known as Pott's fracture. It is often caused in the same way as an ankle sprain so can be difficult to tell apart initially. Lateral ankle sprains are more common and so fractures to the lateral malleoli also tend to occur more frequently.
Initially, careful palpation or feeling of the malleolus and surrounding area can indicate that a fracture may or may not be present. Maximal tenderness on the bone may indicate a fracture, whereas if the area just forward or under the bone is more tender, this may indicate a ligament sprain.
An x-ray is the only way to determine for definite if a fracture is present. Early x-rays may not clearly show this due to swelling and bleeding in the area and so if a fracture is suspected, then a second x-ray may be requested once the swelling has gone down.
Treatment of Pott's fracture
Depending on the severity of the injury surgery may be required to fix internal bones of the ankle which may have moved. Spiral fractures of the lateral malleolus and posterior malleolus do not usually require fixation and are treated without surgery using crutches and mobilization exercises early on.
Lateral malleolar fractures with instability on the inside of the ankle and hairline medial malleolar fractures could become unstable and are usually treated with a plaster cast fitted below the knee for 6 weeks.
Less severe fractures may be treated with an ankle brace or walking boot. A full strengthening and ankle rehabilitation program should be undertaken to include wobble board or proprioception training.
Fractures where the bones have been displaced may require surgery to reduce them or put them back in the correct position.