I’m having some trouble understanding displaced avulsion fractures particularly of the ankle. I’ve heard folks say that even displaced avulsion fractures can heal on their own without surgery. Say for instance the atfl pulls a section of bone off of the fibula during an inversion type injury and the ligament coils up. How would the section of bone and the ligament spontaneously heal if they’re not attached? What am I missing here?
Just my two cents, but typically we think about healing as “radiographic” and “clinical” healing. In your example, the person who has an avulsion fracture of their lateral fibula will never have that piece “re-attach” to the malleolus. Additionally, if the ATFL is completely torn, it won’t magically re-attach either. However, if given enough time, the body is incredibly adaptive and learns to “live” with it’s new state. Bone is metabolically active, so the portion that was lost will be filled in with new bone, but the bone fragment will still be there. Also, the ATFL is a nice thing to have, but not necessary for someone to live a long, healthy life. However, given enough time and some rehab, the patient should start to improve until they reach the point of “clinical” healing, meaning they are pretty much back to their baseline. There are plenty of people that I see who still have avulsion fragments in their ankles from previous injuries, but are totally fine now, and nothing needs to be done unless that fragment finds its way into the joint and causes mechanical type issues (locking, catching, etc). So, not very satisfying, but that is how I think about it. Just m thoughts
No, thank you that’s quite helpful. A follow up question, so a partial or non-displaced avulsion fracture is kind of just hanging on by a piece of bone that’s still in place? Is that piece at risk of further displacement to becoming fully displaced if not immobilized?
So a fully displaced avulsion would be completely separated from the bone, and partially would still be hanging on. And yes, technically any partial avulsion could be made worse with excessive force, but it depends on the area whether or not it needs immobilization. Fracture care is so individualized for each fracture that it’s hard to speak in generalities.
Thanks for the info!
May I ask, are you an orthopod, PT or what?