Ankle Fracture

An ankle fracture, also known as a broken ankle, is most commonly caused by the ankle twisting or rolling from tripping, falling, or an impact from an accident. Two joints are involved in ankle fractures, the ankle joint where the tibia, fibula and talus meet, and the syndesmosis joint, the joint between the tibia and fibula.

Ankle
Courtesy of the American Association of Orthopaedic Surgeons

Ankle fractures can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place. Some fractures may involve injuries to ankle ligaments that keep the ankle bones and joint in its normal position.

SYMPTOMS

One or all of these symptoms may indicate an ankle fracture:

• Immediate and severe pain at the site of the fracture, which can extend from the foot to the knee.
• Swelling, which may occur along the length of the leg or be more localized at the ankle.
• Bruising and tenderness to the touch.
• Decreased ability to walk. It is possible to walk or bear weight upon the ankle with less severe fractures. Never rely on walking as a test of whether the ankle is fractured.
• Deformity or bones protruding through the skin, a condition known as an open ankle fracture. These types of ankle fractures require immediate treatment to avoid problems like infection.

Most patients with ankle fractures are treated in an emergency room or a doctor’s office. An X-ray of the damaged ankle may be taken to determine what the fracture looks like, which bones are broken, how separated or displaced the bones are, and to find out the condition of the bone itself. The X-ray will help determine the proper course of treatment. In some cases special x-rays called stress x-rays are needed.

TREATMENT

Ankle Fracture
X-ray of an Ankle Fracture

You may not require surgery if your ankle and the broken bone is not out of place or just barely out of place. The type of treatment may also be based on where the bone is broken.

• Elevation and ice to reduce painful swelling and decrease the risk of damage to the surrounding tissue.
• A splint, worn for several days, may be placed to support the broken ankle and allow room for swelling. If the damaged ankle is not displaced, the splint may be applied immediately without moving the broken ankle. However, if the bones are displaced and/or the ankle joint is dislocated, a closed reduction is performed while the splint is placed. This treatment involves setting the tibia and/or fibula bones and ankle joint to improve the position and pain at the ankle. This treatment may require some type of anesthesia.
• Rest and avoiding weight bearing upon the ankle is essential to healing correctly. Crutches, walkers and wheelchairs are usually recommended, depending on the severity and type of ankle fracture. In many cases, a patient will not be able to place any weight on the ankle for several days,
weeks or even months. Your physician will make this determination.
• A cast or fracture boot can be applied to a fractured ankle once the initial swelling goes down. These are most commonly used to treat fractures where one bone is minimally displaced and not requiring surgery. Both a cast and a boot can provide adequate immobilization and protection to the ankle. A cast cannot get wet or be removed without special tools. A boot can be removed for bathing and sleeping. The type of fracture and the physician’s judgment will determine the best type of immobilization. The cast or boot is worn until the fracture is fully healed, which usually takes two to three months.
• The need for surgery will largely depend on the appearance of the ankle joint on the X-ray and the specific type of fracture. Badly displaced fractures and fractures of both the tibia and fibula commonly need surgery. During this type of procedure, the bone fragments are first repositioned into their normal alignment and are held together with special screws and metal plates attached to the outer surface of the bone. In some cases, a screw or rod inside the bone may be used to keep the bone fragments together while they heal. Restoring alignment of the broken bone is essential to full recovery because ankle arthritis can occur if a fracture heals improperly. The best way to minimize the risk of arthritis is to restore the ankle to as close to normal as possible.

There are usually few complications from a broken ankle, although there is a higher risk among diabetic patients and those who smoke. Your orthopaedic surgeon may prescribe a program of rehabilitation and strengthening. Range-of-motion exercises are important, but keeping weight off the ankle is just as important.

Ankle fractures in children are more likely to involve the tibia and fibula, which typically involves the growth plates. Growth plate fractures in the ankle often require immediate attention because the long term consequences may include legs that grow crooked or of unequal length. A child who breaks an ankle should be checked regularly for up to two years to make sure that growth proceeds properly.


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