What to Expect When You Fracture Your Ankle

UFAI_ankle_pictureA broken ankle, or ankle fracture, is a common injury that is sustained most commonly with twisting of the ankle.  The ankle is comprised of three bones, 2 long bones in your leg, (tibia and fibula) and a bone that sits between the heel bone and the leg, called the talus. Holding the joint together are several ligamentous complexes that can be torn depending on the severity of the fracture.

These ligamentous complexes include the deltoid ligament (holding the talus and tibia together), the lateral collateral ankle ligaments (holding the talus and the fibula together), and the syndesmotic ligament (holding the tibia and fibula together).  Not all ankle fractures are the same, and treatment can vary depending on the type of ankle fracture you sustained.

How do ankle fractures happen?

Ankle fractures are most commonly sustained with a twisting or rolling of the ankle.  It can also happen with a direct impact.  An audible break may be heard.  Often, patients will find it difficult and painful, if not impossible, to weightbear on the ankle.  It will be tender to touch and very painful.  The ankle will often swell and become bruised.   The ankle may look dislocated and there may be a visible deformity present.

How’s an Ankle Fracture Diagnosed?

Ankle fractures are diagnosed with a history and physical exam of the ankle.  If an ankle fracture is suspected, x-rays are often ordered to evaluate the injury further.   X-rays give doctors a view of the ankle bones, and will show any break that is present, along with the alignment of the ankle joint.

A stress x-ray may be taken to test the integrity of some of the ligaments if it is not shown on regular x-rays.  MRI may also be done to evaluate ligamentous injury to the ankle.  If the ankle fracture is severe and in multiple pieces and extending into the ankle joint, a CT scan may be helpful to further evaluate the bone fracture.

 What are the Treatment Options for a Broken Ankle?

Depending on the severity of the ankle fracture, patients may or may not require surgery to repair their ankle.  Conservative treatment often will consist of immobilization in a cast or boot, depending on the severity of the fracture.

If surgery is needed, patients will be immobilized in a cast for at least 6 weeks as the bone heals.

How to Determine if Ankle Surgery is Necessary?

If the patient is healthy enough to undergo surgery, there are several factors in determining if a fracture requires surgery.

Is there displacement of the bone and/or joint?

If the break in the bone is out of place, or the ankle is out of alignment, surgery is recommended to place the bone back in place.  Screws and plates are used to hold the bone in place as it heals

What’s the size of fracture fragment?

Sometimes only a small chip fracture is present at the tip of the bone.  These fractures require no surgery to repair and will only require a period of immobilization.

How is the stability of ankle?

Ankle fractures are considered unstable once there are 2 or more visible breaks on the ankle.  Additionally, an ankle can be unstable if the syndesmotic ligament (ligament between tibia and fibula) has been torn.

This can be tested on stress x-ray.  The goal of surgery is to stabilize the fracture and ligaments by holding them together with screws/plates as the bone heals.

Conclusion

Ankle fractures are very common injury and it is important to have a professional check your ankle, especially if you are having pain and trouble walking on the area.  Ankle fractures that cause a malalignment of the joint and that are untreated can lead to debilitating arthritis.

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