Case Study - A triple ankle fracture following a fall.

N.B is a 39 year old woman who sustained a right triple ankle fracture and dislocation following a slip and fall at home. She was brought to A&E where they wanted to operate on her ankle and hold it in place with a plate due to the complexity of the fractures. However, she did not want any metalwork in her ankle and therefore the ankle was just manipulated under anaesthetic back into the correct position. The foot was managed conservatively and put in a cast for 6 weeks and following this into an aircast boot.

N.B. attended Aqua physio 2 months after her injury where she was still in the aircast boot and using elbow crutches. Her most recent X-ray showed good healing but one fracture remained. She was advised by her consultant that she can start to wean out of her boot and had just started to walk indoors without the boot.

N.B was examined by one of the aqua physiotherapists which revealed she could mobilise without the boot but had a limp and reduced weight bearing on her right leg. There was a lot of swelling around the ankle and foot. She has very poor movement in her ankle joint. She was unable to stand alone on her right leg or rise up onto her toes using both feet. She was afraid to weight bear on the ankle in case it prevented full healing of the fractures.

Following from the examination an exercise program was created using the properties of water to assist in her rehabilitation. We worked on gait re-education, weight transfer, ankle mobilisation, strengthening, proprioception and C.V  fitness.

Performing the exercise in the water also helped reduce the swelling around the joint and gave her confidence to put more weight through the foot.

N.B has had 6 sessions so far in the water and she is now mobilising on land without the boot or crutches with nil limp. She has regained 90% of her ankle movement and her ankle strength has progressed brilliantly.

She still gets some ache in her foot after walking a lot but this is reducing and we will continue to work with her in the pool to help eliminate this so she can return to her pre-injury level of function.