Bo Nix suffered a fracture in his right ankle late in the Denver Broncos’ 33–30 overtime win vs. the Buffalo Bills in the AFC Divisional Round of the NFL playoffs.
The injury happened on a designed run/play shortly before the game-winning field goal, and he briefly appeared to continue before the severity was fully known.
X-rays confirmed a broken ankle, and Broncos coach Sean Payton said Nix will miss the rest of the season, including the upcoming AFC Championship Game.
Ankle fractures are one of the most common pathologies seen during the winter months. How do we assess ankle fractures and how are they treated?
Initial management of ankle fractures include reduction of displaced bone fragments if necessary, immobilization, RICE protocol (rest, ice compression, elevation), pain control, and imaging to assess the injury. Radiographs or CT for surgical planning assist with identifying displacement and extent of injury.
How do we determine if surgery is necessary?
Factors that determine surgical vs non-surgical intervention of ankle fractures include stability, displacement, and alignment. For stable fractures that are not displaced, non surgical treatment can include a short leg cast/splint or walking CAM Boot for a period of 6-8 weeks. There is also progression from non weight bearing to partial weight bearing dependent on follow up X-rays to ensure the fracture has not become displaced. Non displaced, isolated lateral malleolar fractures of the fibula are common injuries that can be treated conservatively depending on the physician.
From a surgical standpoint, intervention typically occurs when the ankle is unstable, dislocated, or misaligned. Surgical treatment is often seen with syndesmotic injuries, bimalleolar or tri malleolar ankle fractures. Open reduction internal fixation is performed with screws, plates, pins, or rods to realign the ankle joint. Post operative protocol typically includes non weight bearing from a period of 6-8 weeks, followed by progressive and gradual return to weight bearing over a period of 6-12 weeks.
