Ankle Fracture (Broken Ankle)

What are Ankle Fractures

Ankle fractures, commonly known as broken ankles, are a frequent type of bone fracture in adults. These fractures involve a break in one or more of the bones constituting the ankle joint, namely the tibia (shinbone), fibula (smaller bone of the lower leg), and talus (the small bone sitting between the heel bone, the tibia and fibula).

Ankle fractures can impact specific parts of the tibia and fibula that make up the ankle, including the medial malleolus (inside part of the tibia), posterior malleolus (back part of the tibia), and lateral malleolus (end of the fibula). The nature and severity of the fracture depend on which of these areas are affected.

Types of Ankle Fractures

Ankle fractures are categorised based on the location and nature of the break in the bones that form the ankle joint.

Lateral Malleolus Fracture

This is the most common type of ankle fracture. It involves a break in the lateral malleolus, the bony prominence on the outer side of the ankle, which is part of the fibula. These fractures typically result from a forceful twist of the ankle, a bad landing, or a direct impact on the leg.

Bimalleolar Ankle Fracture

The second most common type, this fracture involves a break in both the fibula and the base of the tibia, affecting two parts of the ankle – the lateral malleolus and the medial malleolus. These fractures are often the result of high-impact injuries like falls or car collisions and are considered severe.

Trimalleolar Ankle Fracture

This involves breaks in three areas of the ankle – the medial, lateral, and posterior malleolus. It usually results from high-energy impacts and is considered the most severe type of ankle fracture.

Pilon Fracture (Tibia Only Fracture)

This fracture occurs through the weight-bearing part of the ankle and is typically caused by high-energy impacts such as a fall from height or a car collision. The tibia can fracture in a single location or may shatter in multiple places around the ankle joint.

Maisonneuve Fracture

A Maisonneuve fracture involves a fracture higher up the fibula, typically near the knee, often accompanied by injury to the ligaments around the ankle.

Symptoms

The symptoms of an ankle fracture can vary depending on the severity and type of the fracture, but several common signs are generally present.

• Pain: The most immediate and noticeable symptom is pain in the ankle joint. This pain can range from mild to severe and is often exacerbated when attempting to move or put weight on the ankle.
• Swelling: Swelling around the ankle joint is a common response to the injury. It can occur both at the site of the fracture and in the surrounding areas.
• Bruising: Bruising can occur on the skin overlying the bone. It may spread over a larger area as time progresses.
• Tenderness: The area around the fracture site is often tender to touch, indicating the location of the injury.
• Inability to Bear Weight: There may be a difficulty or complete inability to stand on the toes or bear weight on the injured leg.
• Ankle Deformity: In more severe cases, especially where dislocation is involved, there may be a visible deformity of the ankle joint.

Causes and Risk Factors

Ankle fractures occur due to various causes and risk factors:

• Rotational Injuries
  The most frequent cause of ankle fractures is a rotational injury, which can happen when the ankle is twisted, turned, or rolled. This type of injury is common during walking, running, or engaging in sports activities.
• Repetitive Stress
  Stress fractures in the ankle can occur due to repetitive stress or impact over time, often seen in athletes or individuals with high levels of physical activity.
• Traumatic Impact
  Traumatic ankle fractures can result from high-force impacts such as falls, car collisions, or other traumatic events. Such impacts can exert pressure on the ankle bones, leading to fractures. Falling from a height, such as off a ladder or in similar situations, can also lead to severe ankle fractures due to the sudden and forceful impact on landing.

Non-Surgical Treatment Options

When an ankle fracture is less severe and the bones are not severely displaced, non-surgical treatment methods can be effective.

• Casting or Bracing
  For minor fractures, immobilisation of the ankle is often achieved through the use of a cast or a brace. This restricts movement, allowing the bones to heal naturally.
• Rest and Limited Weight-Bearing
  The ankle specialist may initially suggest limiting weight-bearing on the injured ankle. This may involve the use of crutches or a walker to avoid putting pressure on the healing bones.
• Physical Therapy
  Once the bone starts to heal, physical therapy may be recommended to restore motion, strength, and function to the injured ankle. Therapy plays a role in regaining mobility and preventing stiffness.
• Medication for Pain Management
  Pain management typically involves over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (NSAIDs). These can alleviate symptoms and control inflammation.

Surgical Treatment Options

In cases of severe ankle fractures, especially when bones are displaced or the ankle joint is unstable, surgical intervention may be necessary.

Reduction

This procedure involves the physical manipulation of the bone fragments to reposition them into their normal alignment. Depending on the level of pain and swelling, a muscle relaxant, a sedative, or a local anaesthetic may be administered.

Internal Fixation

Surgical repair often requires internal fixation using metal hardware like pins, plates, or screws. These devices help maintain the correct position of the bones during the healing process. The hardware may be removed after the fracture has fully healed.

Prevention Strategies

While not all fractures can be prevented, certain measures can reduce the risk.

• Wearing Appropriate Footwear: Choosing the right footwear for different activities can provide adequate support and stability to the ankle, reducing the risk of falls and twists.
• Maintaining Physical Fitness: Engaging in regular exercise to strengthen the muscles around the ankle joint can improve balance and coordination, making injuries less likely.
• Being Cautious on Uneven Surfaces: Extra care should be taken when walking or running on uneven ground to avoid missteps that could lead to an ankle fracture.
• Using Assistive Devices to Prevent Falls: For individuals with balance or mobility issues, using assistive devices like canes or walkers can help prevent falls.
• Avoiding High-Impact Activities if at Risk: Individuals with bone-weakening conditions such as osteoporosis should consider avoiding activities that put excessive stress on the ankles.
• Regular Bone Health Check-Ups: Regular check-ups and bone density tests, especially for older adults, can help in early detection and management of conditions that weaken bones.