Ankle Fractures

How Ankle Fractures Occur
Ankle fractures most commonly occur when there is a twisting injury of the foot under the leg. There are some ankle fractures that can occur with a direct fall from a height. Some ankle fractures occur with low energy, such as mis-stepping off a curb. Others may occur with high energy, such as in a motor vehicle accident or fall from a height.

Fracture is another term for a broken bone.

Ankle Anatomy
The ankle joint is where the talus bone on the top of the foot meets the tibia and fibula bones of the leg. On your ankle there are bumps on the inside and outside that we call the malleoli. The lateral malleolus is the bottom of the fibula bone. The medial malleolus is the bottom of the tibia bone. Most ankle fractures break either one, or both of those bones. In some fractures the undersurface of the tibia, the plafond, may be broken.

Fractures that break one of the malleoli are called either Medial Malleolar or Lateral Malleolar fractures. 

Fractures that break both malleoli are called Bimalleolar fractures. 

A fracture involving both malleoli and the posterior rim of the distal tibia is called a Trimalleolar fracture. 

If the joint surface of the distal tibia, the plafond, is disrupted it is called a Pilon Fracture.

Fracture Pain
Fracture pain is really not like any other type of pain. Most people have a very deep aching feeling that just does not let up. Most patients who have fractures are treated with a combination of narcotics and Tylenol for pain relief. Go here for a discussion of fracture pain.

Initial Treatment
When the ankle is fractured there will be significant swelling and pain. Usually there will be bruising, from bleeding at the fracture site. Any motion of the ankle joint will be painful. An acute ankle fracture should be immobilized, and the ankle elevated with ice put on it. If you suspect you have an ankle fracture you should be taken to an emergency room so an x-ray can be taken.

If you have an ankle fracture diagnosed in the emergency room, a plaster splint will usually be applied. Most patients can be treated at home, though there are instances where it may be necessary for you to come into the hospital acutely. Unless you are admitted you will be sent home with instructions to call me the next day, or Monday morning if it is a weekend.

Xrays
Plain x-rays of the ankle are generally satisfactory to describe the fracture. There are some fractures that need to be evaluated with further testing, usually a CAT scan. You will be advised if that will be necessary.

Joint Injury
The problem with any fracture that involves a joint is that unless the bones that are broken are put back to where they normally should be, the joint may be permanently damaged. Damage to the lining of the joint is called Arthritis.  With some ankle fractures the bones will not have shifted much, or displaced. If that is the case, the fracture can generally be treated by putting a cast on the leg, to protect it while the bones heal. If, however, the fracture has caused the bones to shift, it may be necessary to do surgery to move the bones back to where they should be. If that is the case, it may be necessary to put metal screws, plates or pins into the bones to hold them in the proper alignment.

Fracture Healing
Each fracture is different, and each person with the fracture is unique. A decision on the proper treatment for your fracture requires a thorough evaluation and discussion with you. Your fracture will have began the process of healing from the instant the bone was broken.  Whether it is best to allow that to proceed in a cast, or whether surgery is a better option will depend on many factors that you need to discuss with an orthopaedic surgeon.