Ankle Fracture

What is an ankle fracture?

An ankle fracture is also called a broken ankle. Ankle fractures occur when one or more of the three bones that make up the ankle joint crack or break. The bones of the ankle joint include the tibia (shinbone), the fibula (outer ankle bone), and the talus (the bone that connects the leg to the foot). An ankle fracture is different from an ankle sprain or strain, which occurs when damage occurs to the ligaments, tendons or muscles. In an ankle sprain, the soft tissue can be damaged, but the bones remain intact without fracture or break. Ankle fractures need to be treated differently than ankle sprains and it is important to get a proper diagnosis. The experts at BICMD can diagnose an ankle fracture during a telemedicine visit. They will offer the best and most up-to-date treatment advice for your specific ankle injury.

What causes a broken ankle or an ankle fracture?

The causes of an ankle fracture can vary as drastically as the type of ankle fracture, rather it is a stress fracture, full break or displaced compound fracture. Some causes of a broken ankle include:

• Accidents or trauma
• Rolling the ankle
• Forceful twisting of the ankle
• Tripping or falling
• Impact during sports

What types of ankle fractures are there?

Three bones make up the ankle joint and any one of these bones can break. Because of this, there are several different types of ankle fractures.  Orthopedic ankle specialists think of the ankle as having 3 sides and a “roof.” The lower end of the tibia forms the roof and medial (inside) of the ankle. The lower end of the fibula forms the lateral (outside) and posterior (back) of the ankle. Doctors describe the types of ankle fractures based on these bones and where they are located. Common fractures include:

• Pilon fracture – An ankle fracture or break through the weightbearing tibia (or roof) of the ankle on the middle of the lower tibia. This type of ankle fracture is usually caused by a high-energy trauma like a fall from a great height
• Lateral malleolus fracture – The most common ankle fracture, which is a break in the lateral (outside) malleolus (the bump on the outside of the ankle on the end of the fibula).
• Bimalleolar ankle fracture – The second most common ankle fracture; when the both the lateral malleolus and the medial (inside) malleolus breaks. The medial malleolus is the bump on the inside of the ankle at the bottom of the tibia.
• Trimalleolar ankle fracture – A break or fracture in three of the ankle bones: the medial and lateral malleolus, and the posterior malleolus (back of the fibula, at the bottom).
• Maisonneuve fracture – A fracture that occurs in the fibula, closer to the knee instead of the ankle. This type of fracture involves the complete disruption of the ligaments in the ankle and may not always show up in an x-ray. Maisonneuve fractures are often found with an MRI Scan instead of an x-ray.

Displaced -vs- Non-Displaced Ankle Fracture:

Any of the above types of ankle fractures can be displaced or non-displaced. A non-displaced fracture occurs when the bone is broken, but still in its correct anatomical position and alignment. Displaced ankle fractures describe the broken bones which are out of correct alignment or separated from one another.

What are the symptoms of a broken ankle or ankle fracture?

The symptoms of an ankle fracture can vary greatly, depending on the type and area of fracture. Some fractures, like hair line fractures, are slight, and patients can walk on the ankle, others can cause extreme ankle instability and pain. General symptoms of a broken ankle are:

• Immediate and severe pain
• Pain, felt especially during weightbearing
• Swelling and tenderness
• Bruising
• Visual deformity, the ankle looking out of place
• Inability to place any weight on the ankle
• Feeling of ankle instability

How is an ankle fracture diagnosed?

Ankle fractures are usually diagnosed from the examination of an x-ray. Ankle fractures often go hand-in-hand with a soft-tissue injury, such as a ligament strain or sprain and can require further testing. Other diagnostic testing may include a CT Scan or an MRI Scan.

What is the treatment for an ankle fracture or broken ankle?

Non-surgical treatment:

The goal of ankle fracture treatment is for the broken bone to heal as closely to perfect as possible. The area, or level in which the bone breaks often dictates treatment. If the bone is stable, non-displaced and aligned properly, surgery may not be needed. It is important to obtain a second opinion and correct diagnosis for a broken ankle. The malalignment of a few millimeters can cause problems later, like arthritis, and early corrective treatment is important.

Surgical treatment:

The exact type of surgical treatment will vary, based on which bones are broken, where the break occurred and if it is fragmented or displaced. Surgery for a broken ankle, regardless of the location or type, usually includes the following:

• Reduction – The process of moving the non-aligned or misplaced bones back into their correct position.
• Immobilization – The bones are held together surgically using special screws, metal plates, rods or wiring techniques. This will secure the bones so they heal together properly. Terms associated with the immobilization of the bones during surgery and the names of treatments used may include:
  • Internal fixation of fractures
  • External fixation of fractures
  • Intramedullary nailing of fractures
  • Repair of malunions and non-union

The foot and ankle are then often placed in a cast or brace for several weeks so the bones can heal.

• Removal of hardware – This is only done if the hardware used to correct the break and displacement begins to be painful or irritating. A skilled surgeon will carefully remove the hardware after the bone has completely healed.

How long does it take an ankle fracture to heal?

Healing time is always dependent upon the patient’s health, age, activity level and underlying health conditions. The average time for a broken bone to heal is 6 weeks. Ankle injuries can take longer to heal if the ligaments and tendons were involved. X-rays should be repeated to understand the rate of healing and if the bones are aligning correctly. Overall, most patients can begin some form of physical therapy and strengthening after the bone has healed, at about 8 weeks. Return to sport and full strength of the ankle varies greatly, depending on the injury. Hairline fractures can take only 6-8 weeks where a complete break with internal or external fixation can take up to a year.

For more information about ankle fractures or a broken ankle or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic ankle specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.