Question:

One week ago, my 17 year old son had an ankle injury following a soccer match. It swelled up and he could not walk on it.X rays were taken.

This is the Xray report:

Soft tissue swelling over the lateral malleolus and anterior ankle is noted. A small 3mm calcific density is seen projected over the medial ankle joint seen only on the frontal view. The exact location is uncertain but is suspected to be within the ankle joint and is suspicious for a fracture fragment. The donor site may be in the distal tibial articular surface medially where there is a very faint cortical irregularity .

My family physician has told me that these bone fragments will be dissolved by the body and to proceed with physio treatment for a sprained ankle.

I am concerned about a bone fragmet in the joint and if it can dissolve and whether it will cause any problems now or in the future. It is one week since the injury. He is on crutches and the swelling is coming down.

Should I see another doctor and what sort of questions should I be asking

Answer:

The term ankle sprain refers to injury to ankle ligaments… the X-ray findings indicate your son’s injury may be a fracture – as well as perhaps also a sprain. X-rays reveal bone but not cartilage, which means that if there is a fragment in his ankle joint, it may be composed of cartilage along with bone, and therefore be larger than the 3mm size noted in the X-ray report….

Although it’s good your son’s ankle swelling is improving, if he’s not yet begun weight-bearing on that side, it’s unknown whether his ankle function is also improving… that is, if there truly is a bone fracture fragment within his ankle joint, bearing weight on that side could cause pain, recurrent swelling, instability/give-way symptoms, and/or joint locking symptoms.

Consider asking your physician about getting a second opinion from a sports-oriented orthopedic surgeon – preferably one who specializes in foot and ankle problems – to discuss the advisability of resuming weight-bearing on the injured side at this time.  Also, the possibility an ankle MRI scan may be worth considering to clarify the extent (if any) of injury to ankle ligaments and/or cartilage, as well as whether or not ankle surgical intervention should be considered.

For more information:

Go to the Sports Medicine health topic.