FAQs on Ankle Fractures
Ankle fractures account for about 12 percent of all bone fractures with about a million Americans treated for the injury every year. These fractures are second most common form of ankle injury after sprains. While young adults are most affected among men, women aged 50 to 70 years are at the increased risk of ankle fractures.
What is ankle fracture?
An ankle fracture refers to partial or complete break in any of the bones in the ankle. The ankle has three important bones – tibia or shinbone on the inner part, fibula or lower leg bone on the outer part, and talus or the bone that connects tibia and fibula with the heel bone. Ankle fractures occur when there is a break in the distal fibula, distal tibia, or talus.
The majority of ankle fractures are malleolar in nature. It means these injuries mostly occur in one or more of the three malleolus or bony protuberance on both sides of the ankle, namely medial malleolus (on the inner part of the tibia), posterior malleolus (on the rear tibia), and lateral malleolus (on the lower end of fibula). About 70 percent of these are unimalleolar fractures occurring in one malleolus. Bimalleolar fractures involving medial and lateral malleolus account for 20 percent instances while incidents of trimalleolar or three- malleolus fractures are limited to just 10 percent.
How does ankle fracture occur?
Ankle fractures occur when the ankle twists or rolls inward or outward. It can be a minor one that many mistake for a sprain and range from hairline fracture to avulsion injuries. Major fracture serious enough to cause complications may also happen when bones are broken and shattered.
Such type of fractures impact two joints in the ankle along with their connecting bones and ligaments.
- Aankle joint, the meeting place of tibia, fibula, and talus and responsible for ankle’s backward bending and foot flexion
- Syndesmosis joint, the meeting place of tibia and fibula and responsible for ankle’s inward and outward movements
Ankle fractures also result in injuries to ligaments in these joints leading to ankle losing its normal strength, position, and motion.
According to the Danis-Weber classification, first proposed in 1949 and modified in 1972, ankle fractures impacting fibula can be of three types.
- Type A fracture impacting “fibula below the syndesmosis joint” (similar to sprain/ hairline fracture)
- Type B fracture impacting “fibula at the syndesmosis joint” (dislocation)
- Type C fracture impacting “fibula above the syndesmosis joint” (rupture)
Doctors use various terms to indicate ankle fractures. This include
- Snowboarder’s fracture associated with too much ankle backward bending or turning inside out.
- Pilon fracture caused by injury to distal tibia from motor accidents or fall from a height linked to sudden weight or force on it.
- Pott’s fracture in the lower fibula largely due to forcible external rotation of the ankle and mostly bimalleolar in nature.
- Maisonneuve fracture involves two fractures one in the proximal fibula and the other impacting the inner part of the tibia while disrupting the syndesmosis joint.
What are the symptoms of ankle fractures?
- Immediate and severe pain in and around ankle
- Fracture-site pain
- Swelling in the injured area
- Pain worsens with placing weight on the foot
- Ankle joint deformity
- Inability to walk varies with fracture severity
What are causes of ankle fractures?
- Ankle twisting
- Forcible rotation of ankle
- Excessive forward or backward rolling of ankle
- Falling from a height
- Tripping and missteps during walking or running
- Motor accidents impacting the tibia or fibula
- Excessive weight impact
- Stress fractures due to overuse
- Weakened bones due to osteoporosis
What are complications of ankle fractures?
Unless treated on urgent basis and effectively, ankle fractures may result in compression of or damage to nearby nerves and blood vessels. If it affects the joints in the ankle, instability, disability, and arthritis are possible consequences. Osteomyelitis or bone infection is a big risk if the fracture is open causing bones exposed to bacteria.
Who are at the risk of ankle fractures?
High-impact activities or sports may cause ankle fractures where there is potential risk of ankle twisting, excessive stress, or forcible rotation. Using improper shoes a faulty training techniques add to the risk. Those with fragile bones or joint or overweight also face the threat.
How is ankle fracture diagnosed?
A detailed evaluation of pain, swelling, and other symptoms associated with ankle fractures is crucial for its diagnosis. The reason and conditions leading to the ankle injury also matter. Imaging tests, including x-rays and MRI, enables to locate the broken bone area and its dislocation. Doctors may conduct stress test by making your ankle subject to pressure and take the x-ray simultaneously.
What are the treatment methods available for ankle fractures?
- Self-Care: Stay off the injured ankle and remain off from high-impact activities. Rest is essential to avoid further injury. Apply ice pack regularly and keep the ankle elevated to reduce swelling. Having an elastic wrap around the ankle also keeps it stabilized and prevents further soft tissue damage.
- Supportive Devices: A splint can be placed around the broken ankle to control swelling and enhance its stability. It works in both conditions, only fracture and dislocation following fracture. In case of dislocation, it is essential to use the splint only after “the tibia and/or fibula bones and ankle joint to improve the position and pain” or closed reduction procedure. Crutches or wheelchairs also assist in keeping weight off the ankle.
- Immobilization: When there is severe ankle fractures leading to dislocation, cast or fracture boots are used to keep it immobilized for a period of time. This prevents further stress while allowing the healing.
- Medications: Pain relievers help reduce pain and assist in the rehabilitation following ankle fractures.
- Therapy: Once the bone is healed, mild stretching and massage help overcome stiff muscles and ligaments. Such therapies also restore ankle strength and flexibility.
- Surgery: Surgical intervention is used to treat badly displaced fractures and dislocations. It is common when both tibia and fibula are broken. The procedure involves internal fixation or restoring the alignment.
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