By Dr. Jeff Daniels EBS Medical Columnist
One of the most unique injuries we see at the Medical Clinic of Big Sky, an injury not seen in any other sport or activity, is a fracture deep inside a snowboarder’s ankle.
Never described before snowboarding started in the early 90s, this injury can have devastating consequences if not properly diagnosed and treated. And, amazingly, few snowboarders know about it.
In Vail, Colo., when snowboarding was a new sport, a group of orthopedists observed several young men who were limping months after suffering ankle injuries. A majority of these injuries were on the left side, the front or lead foot for most snowboarders. All had X-rays taken immediately after their injuries, and when no obvious fracture was noted, the doctors diagnosed ankle sprains.
People generally recover from sprained ankles within a week or two, but these patients did not. When re-evaluated several months later, X-rays showed a poorly healed, fractured bone deep inside the ankle. And each break was in the same spot: the lower, outer edge of the talus bone, one of the three important bones in the ankle joint.
The Vail orthopedists decided to study this phenomenon, and quickly noted that the mechanism of injury in the majority of these cases was related to a jump, or more precisely, a jump that was not landed well. The ankle pain and swelling was enough to get these guys to seek emergency care, and the ankle X-rays that were taken, even after close review, did not reveal the crush fractures that were noted later.
These astute orthopedists realized that by missing these fractures, the ankle sustained irreversible damage because the bone fragments solidified in abnormal ways, leaving the ankle permanently arthritic.
The Vail doctors set up the study to identify these injuries before damage became irreversible. When the mechanism of injury involved a jump, and resulted in ankle pain and swelling in the lead foot, a CT scan was offered. It became apparent that even though X-rays were negative, a CT scan could easily demonstrate the crush injury of the bone. The doctors then determined that surgery would be necessary to return the ankle to normal.
Many doctors now recognize and diagnose this type of snowboarder ankle injury, more formally know as a fracture of the inferolateral border of the talus. However, I’m amazed that most snowboarders who come in with this injury, as well as most students and residents I teach in my clinic, have no clue as to what it is.
The way I recognize this injury in snowboarders, after matching the mechanism of the injury to the original reports, is by examining the ankle and finding more swelling and black and blue than what I would expect in a simple sprain of the same area.
Pain is on both sides of the ankle, even though the injury is on one side. We perform X-rays because we sometimes see the fractures, but if we can’t, a CT scan of the ankle is highly recommended.
Over the years since I heard the lecture from those Vail orthopedists in 1997, I’ve identified this injury in about 50 snowboarders, or about three per ski season. If the injury would have gone undiagnosed, they all might still be limping today.
Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.