What Is an Ankle Fracture?
A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula or both.
Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
An ankle fracture is accompanied by one or all of these symptoms:
- Pain at the site of the fracture, which in some cases can extend from the foot to the knee.
- Significant swelling, which may occur along the length of the leg or may be more localized.
- Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon.
- Bruising that develops soon after the injury.
- Inability to walk; however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether or not a bone has been fractured.
- Change in the appearance of the ankle—it will look different from the other ankle.
- Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.
Following an ankle injury, it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.
The affected limb will be examined by the foot and ankle surgeon who will touch specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.
Treatment of ankle fractures depends on the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the RICE protocol:
Rest: Stay off the injured ankle. Walking may cause further injury.
Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Compression: An elastic wrap should be used to control swelling.
Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.
Additional treatment options include:
Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or anti-inflammatory drugs.
When Is Surgery Needed?
For some ankle fractures especially displaced fractures, surgery is needed to repair the fracture and other soft tissue-related injuries. The foot and ankle surgeon will select the procedure that is appropriate for your injury.
It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis and chronic pain.
Lateral view after a temporary external fixator has been placed
Anterior view of the same ankle with external fixator in place
AP view after final ORIF.
Lateral view after final ORIF
Lateral view of a displaced ankle fracture
AP view of the same displaced ankle fracture
External fixator has been placed to allow the soft tissue swelling to reduce before final ORIF of the ankle
Interoperative confirmation that the joint is reduced with an external fixator