Joba Chamberlain, pitcher for the New York Yankees, suffered from a serious open ankle dislocation on Thursday and underwent surgery for the injury. After recovering from Tommy John last June, this will be another big setback for this young pitcher.

ANATOMY

The ankle is made up of three bones: the fibula (on the outer part of the ankle), the tibia (on the inner part of the ankle), and the talus (on the central part of the ankle). Between the tibia and fibula, at the level of the ankle joint, is a ligament which holds these one together, called the syndesmosis.

In an ankle dislocation, the talus comes out of the “socket”. When coming out of the joint, the skin may or may not rip open. If the skin opens, this is known as an open dislocation. If the skin does not rip open, then it is known as a closed dislocation.

When the ankle dislocates, any of the bony structures can fracture/break or the tendons around the ankle tear. Finally, the ankle joint or the subtalar joint (the joint beneath the ankle that allows the foot to move in and out) can be damaged.

CAUSES

An ankle dislocation can occur whenever the ankle is twisted to its maximum point. Rarely, can this happen with bad ankle sprains. More often, the athlete turns or twists the ankle with a fall, motor vehicle accident, or jumping activity.

SYMPTOMS

Individuals who dislocate the ankle will have pain, swelling, loss of motion, and bruising. A lump or bump will be seen around the ankle. If the skin breaks open, the ankle bone may be seen.

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a dislocated ankle, you should seek medical attention immediately. A physical exam and x-rays are usually performed. A CT or MRI scan at times may be needed. The ankle will need to be placed back into the alignment.

TREATMENT

Ankle dislocations that are closed can often times be put back in place, or reduced, without surgery. If there is no associated break of a bone or tendon injury, the leg is kept in a cast for a few weeks to allow the soft tissue to scar in and stabilize. Then a lot of physical therapy is needed to work on the range of motion and strength.

If an ankle fracture is open, the athlete must go to the operating room so that the wound can be washed out. The joint is put back in place and any broken bones, if present are fixed. Depending on how large the skin laceration is, infection is a serious and real risk. Again, the leg is kept in a cast for a few weeks to allow the soft tissue to scar in and stabilize. Any bones that may be broken will take 6-8 weeks to heal before the athlete can walk on the leg. Once the cast is off, a lot of physical therapy is needed to work on the range of motion and strength.

OUTCOMES

Ankle dislocations can be career ending for an athlete, especially if there are associated injuries. Pain, loss of motion, and loss of strength can be long term issues that do not allow the athlete to return to competitive sports.

RETURN TO ACTIVITIES

From the current reports, it is unclear if Chamberlain has any associated injuries. This is a serious injury. If Chamberlain is able to return to the pitching mound, it will be late in the season this year.

Dr. P

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