Ankle Fractures

What is an Ankle Fracture?

Ankle injuries are prevalent in athletes and individuals performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can be from a torn ligament (ankle sprain) or broken bone (ankle fracture).

An ankle fracture is a painful condition with a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injured during an ankle fracture.

What is the Normal Ankle Anatomy?

The ankle joint is composed of three bones: the tibia, fibula, and talus, which articulate together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule filled with synovial fluid to enable smooth movement.

What are the Common Causes of Ankle Fractures?

Ankle fractures can occur from excessive rolling and twisting of the ankle – usually from an accident or activities such as jumping or falling, which cause sudden stress to the joint.

What are the Symptoms of an Ankle Fracture?

With an ankle fracture, there is immediate swelling and pain around the ankle and impaired mobility. In some cases, blood may accumulate around the joint – a condition called hemarthrosis. In the case of a severe fracture, deformity around the ankle joint is visible, where a bone may protrude out, piercing the skin.

What are the Types of Ankle Fractures?

Ankle fractures are classified according to their location. The different types of ankle fractures are:

• Lateral malleolus fracture, in which the lateral malleolus, the outer part of the ankle, is fractured
• Medial malleolus fracture, in which the medial malleolus, the inner part of the ankle, is fractured
• Posterior malleolus fracture, in which the posterior malleolus, the bony hump of the tibia, is fractured
• Bimalleolar fractures, in which both lateral and medial malleolus bones are fractured
• Trimalleolar fractures, in which all three lateral, medial, and posterior bones are fractured

How is an Ankle Fracture Diagnosed?

The diagnosis of an ankle injury begins with a review of your history and a thorough physical examination. This is followed by X-rays and a CT scan of the injured area to obtain a detailed view.

Sometimes, pressure is applied to the ankle, and special X-rays are taken. This procedure is called a stress test. This test is ordered to determine the stability of the fracture under stress and decide on the need for surgery. An MRI scan is recommended in complex cases where a detailed evaluation of the ligaments is required.

What are the Treatment Options for Ankle Fractures?

Immediately following an ankle injury and before seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling. The treatment of an ankle fracture depends upon the fractured bone’s type and stability. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.

For non-surgical treatment, the ankle bone is realigned, and special splints or a plaster cast is placed around the joint for at least 2-3 weeks to allow the bones to heal.

With surgical treatment, the fractured bone is accessed by an incision over the ankle area, and then specially designed plates are screwed onto the bone to realign and stabilize the broken parts. The incision is then sutured closed, and the operated ankle is immobilized with a splint or cast.

What is the Postoperative Care for an Ankle Fracture?

After ankle surgery, you will be instructed to avoid applying weight on the ankle and advised to use crutches while walking for at least six weeks.

Your doctor will recommend physical therapy of the ankle joint. After 2-3 months of treatment, you may be able to perform routine daily activities.

What are the Risks and Complications of an Ankle Fracture Treatment?

The risks and complications with ankle fracture treatment include improper casting or alignment of the bones, which can cause deformities and, eventually, arthritis. Sometimes, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.

Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery for repair.