Ankle Fractures

A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are separated into pieces. There may be ligaments damaged as well. Simply put, the more bones that are broken, the more unstable the ankle becomes.

A fractured ankle 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 and may require that you not put weight on it for three months. ure.

Cause

• "Twisting" or rotating your ankle
• "Rolled" your ankle
• Tripping or falling
• Impact during a car accident

Anatomy

Three bones make up the ankle joint:

• Tibia ("shin bone")
• Fibula (small bone on the outside of your ankle)
• Talus (a foot bone)

The tibia and fibula have specific parts that make up the ankle:

• Medial malleolus: Inside part of the tibia
• Posterior malleolus: Back part of the tibia
• Lateral malleolus: End of the fibula
• Multiple ligaments help make the ankle joint stable

Two joints are involved in ankle fractures:

• Ankle joint
• Syndesmosis: The joint between the tibia and fibula, which is held together by ligaments

Symptoms

Because a severe ankle sprain can feel the same as a broken ankle, every ankle injury should be evaluated by a physician.

Common complaints for a broken ankle include:

• Immediate and severe pain
• Swelling
• Bruising
• Tender to touch
• Cannot put any weight on the injured foot
• Deformity ("out of place"), particularly if the ankle joint is dislocated as well

Diagnosis

Besides a physical exam, X-rays are the most common way to evaluate an injured ankle. X-rays may be taken of the leg, ankle, and foot to make sure nothing else is injured.

Depending on the type of ankle fracture, the doctor may put pressure on the ankle and take a special X-ray, called a "stress test." This X-ray is done to see if certain ankle fractures require surgery.

Sometimes, a computed tomography (CT, or CAT) scan is done to further evaluate ankle injuries.

For some ankle fractures, magnetic resonance imaging (MRI) may be done to evaluate the ankle ligaments.

Treatment

Non-Surgical Treatment
Depending on the nature of the fracture, it is possible for certain ankle fractures to be treated in a cast or a splint. These fractures are typically mild in nature and are usually in proper alignment and position.

Although many fractures can be treated without surgery, there is always a risk of fracture displacement and therefore it is of utmost importance to follow up with your orthopedic surgeon as instructed to monitor appropriate healing.

Surgery
Not all ankle fractures are the same, and thus, the extent and type of surgery varies based on the nature and severity of the ankle fracture. The majority of ankle fractures are treated with a form of metal hardware such as plates and screws. These allow adequate stability of the ankle in the appropriate position until healing takes place.

Dr. Samimi is an orthopedic surgeon with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves. He will review the results of your evaluation with you and discuss whether surgery would be the best treatment option. Nonsurgical options will also be discussed. He will thoroughly explain the potential risks and complications of ankle fracture surgery with you.

Outcome

It takes at least six weeks for the broken bones to heal. It may take longer for the involved ligaments and tendons to heal.

While the bones are healing, your physician will probably schedule additional X-rays to see whether the bones are healing and to make sure that there is no movement of the bones. This is typically done more often during the first six weeks if surgery is not chosen.

Although most people return to normal daily activities, except for sports, within 3 to 4 months, studies have shown that people can still be recovering up to 2 years after their ankle fractures. It may take several months for you to stop limping while you walk, and before you can return to sports at your previous competitive level. Most people return to driving within 9 to 12 weeks from the time they were injured.

Rehabilitation

Rehabilitation is very important regardless of how an ankle fracture is treated. When your physician allows you to start moving your ankle, physical therapy and home exercise programs are very important. Doing your exercises regularly is critical.

Eventually, you will also start doing strengthening exercises. It may take several months for the muscles around your ankle to get strong enough for you to walk without a limp and to return to your regular activities.

Weightbearing

Your specific fracture determines when you can start putting weight on your ankle. Your physician will allow you to start putting weight on your ankle when he or she feels your injury is stable enough to do so.

It is very important to not put weight on your ankle until your physician says you can. If you put weight on the injured ankle too early, the fracture fragments may move or your surgery may fail and you may have to start over.

Supports

It is very common to have several different kinds of things to wear on the injured ankle, depending on the injury.

Initially, most ankle fractures are placed in a splint to protect your ankle and allow for the swelling to go down. After that, you may be put into a cast or removable brace.

Even after the fracture has healed, your physician may recommend wearing an ankle brace for several months while you are doing sporting activities.

Complications

People who smoke, have diabetes, or are elderly are at a higher risk for complications after surgery, including problems with wound healing. This is because it may take longer for their bones to heal.

Nonsurgical Treatment
Without surgery, there is a risk that the fracture will move out of place before it heals. This is why it is important to follow up with your physician as scheduled.

If the fracture fragments do move out of place and the bones heal in that position, it is called a "malunion." Treatment for this is determined by how far out of place the bones are and how the stability of the ankle joint is affected.

If a malunion does occur or if your ankle becomes unstable after it heals, this can eventually lead to arthritis in your ankle.

Surgical Treatment

General surgical risks include:

• Infection
• Bleeding
• Pain
• Blood clots in your leg
• Damage to blood vessels, tendons, or nerves
• Risks from the surgical treatment of ankle fractures include
• Difficulty with bone healing
• Arthritis
• Pain from the plates and screws that are used to fix fracture. Some patients choose to have them removed several months after their fracture heals