Broken Ankle (Ankle Fractures)
What is an Ankle Fracture?
A broken ankle is a painful condition where there is 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.
Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament and is called an ankle sprain or from a broken bone which is called an ankle fracture.
Most Common Questions about Ankle Fractures
In this video, Dr. Leroy Butler, D.O., Foot and Ankle Specialist at OINT, answers the most common questions his patients have when it comes to foot and ankle fractures, AKA a broken foot or broken ankle.
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. This is the most common type of ankle fracture.
- 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.
- Syndesmotic injury, also called a high ankle sprain, is usually not a fracture but can be treated as a fracture.
Broken Ankle: Non-displaced vs. Displaced
- Non-displaced ankle fracture: Also known as stable fractures, in non-displaced fractures even though bones are broken, they remain in correct position and alignment. These are normally managed with a walking cast or boot.
- Displaced ankle fracture: Also known as an unstable fracture, happens when fractured portions of bone are separated or misaligned. This kind of fracture can involve the ligaments that hold the joint together, the joint surfaces themselves, or a combination of both. The treatment will be based on fracture alignment and stability of the ankle. These normally require surgery.
Symptoms of a Broken Ankle?
With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases, blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin.
Treatment Options for Ankle Fractures
Immediately following an ankle injury and prior to 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 type and the stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed..
In 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.
With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone to realign and stabilize the fractured 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 putting weight on the ankle by using crutches while walking for at least six weeks.
Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform normal daily activities.
What are the Risks and Complications of an Ankle Fracture?
Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones which can cause deformities and eventually arthritis. In some cases, the 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 to repair.
When to see an Orthopedic Specialist?
If you suspect that you might have a broken foot, Dr. Leroy Butler recommends:
- If unable to bear weight or pulling weight causes severe pain after injury
- Continued foot pain after trying the R.I.C.E. method for a couple of days
- Feeling of instability or “something is wrong” with the ankle/leg
- Extensive swelling or bruising
- If you have an open wound associated with the injury, be seen immediately.
What happens if an Ankle Fracture is Left Untreated?
- If the fracture involves injury to the joint can cause post-traumatic joint damage.
- It may be a type of fracture that can be initially treated nonoperatively but if not treat correctly at the start of the injury, could lead to the displacement of the fracture leading to the need for surgical correction or alignment.
- If left untreated can lead to nonunion of the bone meaning, the bone doesn’t heal
- If left untreated can lead to malunion of the bone meaning, heals in the wrong position which could cause pain or deformity, and perhaps a bigger surgery to correct the secondary problems.
- Fractures associated with wounds can lead to possible infection of the surrounding tissue or bone if not treated promptly.
What is the Normal anatomy of the Ankle Joint?
The ankle joint is composed of three bones: the tibia, fibula, and talus, which are articulated 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 and filled with synovial fluid to enable smooth movement.