Ankle Fracture (Broken Ankle)

What is an Ankle Fracture (Broken Ankle)?

An ankle fracture (or broken ankle) means that one or more of the bones that make up the ankle joint are broken, generally due to trauma or injury.

The ankle joint is made up of three bones:

  • Tibia – shinbone
  • Fibula – smaller bone of the lower leg
  • Talus – small bone that sits between the heel bone and the tibia and fibula

The more bones that are broken, the more unstable the ankle becomes, which can result in surgery and an extended recovery period. With or without surgery, it takes at least 6 weeks for the broken bones to heal and may take longer if there are ligament and tendon injuries involved.

What are the causes?

Ankle fractures are generally due to trauma or injury to the ankle, such as:

  • Twisting or rotating of ankle
  • Rolling of ankle
  • Tripping or falling
  • Impact during a car accident

What are the symptoms?

The symptoms of ankle fractures vary depending on the severity of the injury. A simple break in one bone may not stop you from walking, whereas several fractures may require that no weight be placed on the injured ankle for a few weeks.

Common symptoms for ankle fractures include:

  • Immediate and severe pain
  • Swelling
  • Bruising
  • Tenderness
  • Inability to put weight on the injured foot
  • Deformity, particularly if the ankle joint is also dislocated

A severe ankle sprain can have similar symptoms as a broken ankle. Therefore every ankle injury should undergo a proper evaluation.

What are the treatments?

Ankle fractures can be treated with or without surgery depending on the severity of your injury, your symptoms and your overall medical history.

Nonsurgical Treatment

If your ankle is stable, you may not require surgery. Nonsurgical treatments usually involve some degree of immobilization, ranging from a high-top tennis shoe to a short leg cast.

Surgical Treatment

If the fracture is out of place or your ankle is unstable, you may require surgery. This type of procedure involves the bone fragments being repositioned (reduced) into their normal alignment and held together with special screws and metal plates attached to the outer surface of the bone. In some cases, a screw or rod inside the bone may be used to keep the bone fragments together while they heal.

Types of Ankle Fractures:

What is a Medial Malleolus Fracture?

A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. Fractures can occur at different levels of the medial malleolus.

Medial malleolar fractures often occur with a fracture of the fibula (lateral malleolus), a fracture of the back of the tibia (posterior malleolus), or with an injury to the ankle ligaments.

Surgical Treatment

If the fracture is out of place or the ankle is unstable, surgery may be recommended.

In some cases, surgery may be considered even if the fracture is not out of place. This is done to reduce the risk of the fracture not healing (known as a nonunion), and to allow you to start moving the ankle earlier.

A medial malleolus fracture can include impaction or indenting of the ankle joint. Impaction occurs when a force is so great it drives the end of one bone into another one. Repairing an impacted fracture may require bone grafting. This graft acts as a scaffolding for new bone to grow on, and may lower any later risk of developing arthritis.

Depending on the fracture, the bone fragments may be fixed using screws, a plate and screws, or different wiring techniques.

What is a Posterior Malleolus Fracture?

A posterior malleolus fracture is a fracture of the back of the tibia at the level of the ankle joint.

In most cases of posterior malleolus fracture, the lateral malleolus (fibula) is also broken. This is because it shares ligament attachments with the posterior malleolus. There can also be a fracture of the medial malleolus.

Depending on how large the broken piece is, the back of the ankle may be unstable. Some studies have shown that if the piece is bigger than 25% of the ankle joint, the ankle becomes unstable and should be treated with surgery.

It is important for a posterior malleolus fracture to be diagnosed and treated properly because of the risk for developing arthritis.

Surgical Treatment

If the fracture is out of place or if the ankle is unstable, surgery may be offered.

Different surgical options are available for treating posterior malleolar fractures. One option is to have screws placed from the front of the ankle to the back, or vice versa. Another option is to have a plate and screws placed along the back of the shin bone.

What is a Bimalleolar Fracture (or Bimalleolar Equivalent Fractures)?

“Bi” means two. “Bimalleolar” means that two of the three parts or malleoli of the ankle are broken. (Malleoli is plural for malleolus.)

In most cases of bimalleolar fracture, the lateral malleolus and the medial malleolus are broken and the ankle is not stable.

A “bimalleolar equivalent” fracture means that in addition to one of the malleoli being fractured, the ligaments on the inside (medial) side of the ankle are injured. Usually, this means that the fibula is broken along with injury to the medial ligaments, making the ankle unstable.

A stress test x-ray may be done to see whether the medial ligaments are injured.

Bimalleolar fractures or bimalleolar equivalent fractures are unstable fractures and can be associated with a dislocation.

Surgical Treatment

Surgical treatment is often recommended because these fractures make the ankle unstable.

Lateral and medial malleolus fractures are treated with the same surgical techniques as written above for each fracture listed.

What is a Trimalleolar Fracture?

“Tri” means three. Trimalleolar fractures means that all three malleoli of the ankle are broken. These are unstable injuries and they can be associated with a dislocation.

Surgical Treatment

Each fracture can be treated with the same surgical techniques as written above for each individual fracture.

What is a Syndesmosis Injury?

The syndesmosis joint is located between the tibia and fibula, and is held together by ligaments. A syndesmotic injury may be just to the ligament — this is also known as high ankle sprain. Depending on how unstable the ankle is, these injuries can be treated without surgery. However, these sprains take longer to heal than the normal ankle sprain.

Surgical Treatment

In many cases, a syndesmotic injury includes both a ligament sprain and one or more fractures. These are unstable injuries and they do very poorly without surgical treatment.