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Why do we go to broken ankles?

If you look at an average day on our incident report (not that there is such a thing as an average day really!) you will see on occasion we respond to patients who we list as sustaining a ‘broken ankle’. As a charity funded service we’re often asked “why do you go to just a broken ankle? Surely that’s just a waste of resources?”

Although we cannot comment on individual cases, with Harrison Ford recently making the headlines after being airlifted from Pinewood Studios by the Thames Valley Air Ambulance with a reported ‘broken ankle’, we thought this would be an ideal opportunity to provide an overview of why we respond to patients with this type of injury.

Breaking any bone can obviously be extremely painful and uncomfortable, however what some people may not appreciate is that the generic term of ‘broken ankle’ more often than not relates to something far more complex than a fracturing, the medical name for breaking, a single bone.

Evolution has seen the bones in our legs and feet become very strong so they are able to hold our weight not just whilst standing or walking but also when we are running and jumping. The forces required to break these bones are often more considerable than those needed to break a bone in other parts of our bodies, such as our wrist, and when attending a ‘broken ankle’ our aircrew often encounter a patient with a serious injury. This is because the lower part of the leg actually has two bones not one, both of which tend to get broken at a point above the ankle rather than the ankle itself being the site of the injury. As such what most people call a ‘broken ankle’ is in fact a double fracture of the leg. This in itself can be a serious injury however the nature of the forces involved in breaking both the bones in the leg often also results in the bones becoming dislocating from the ankle as well just before they break. This fracture/dislocation injury frequently results in the blood vessels supplying the foot becoming ‘kinked’ which means that on top of an already serious injury there can also be a time critical element in needing to restore the circulation to the patient’s foot as soon as possible.

The above situation can be further compounded when a patient sustains this type of injury in one of the many remote areas of Devon such as Dartmoor, isolated coves or on one of our many hundreds of miles country or coastal footpaths. In such circumstances there is a very real potential for what on the face of it may only seem like a ‘broken ankle’ becoming a life changing injury. This is especially true if help isn’t able to arrive quickly, not just relieve the significant pain patients often experience, but to restore any lost circulation to the foot and to airlift the patient to hospital quickly before the elements contribute to hypothermia setting in during the colder months.

By Nigel Hare, Operations Director of Devon Air Ambulance Trust

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