Broken ankle (Ankle Fracture)

Three bones make up the ankle joint; the tibia (shin bone), the fibula (small bone on the outside of the ankle) and the talus (one of the bones in the foot).  Ankle fracture refers to one or more of these three bones being separated into pieces. The more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well.

A fractured ankle can range from a simple break in one bone, which may not hinder walking, to several fractures, which forces the ankle out of place and may require non weight bearing for three months.

Broken ankles affect all ages. They occur in 184 per 100,000 persons per year. During the past 30 to 40 years, there has been an increase in the number and severity of broken ankles, due in part to an active, older population of “baby boomers.”

Symptoms

Pain is the main symptom.  Severe ankle sprains can cause a similar amount of pain.

Diagnosis

Besides a physical exam, X-rays are the most common way to evaluate an injured ankle. X-rays may be taken of the leg, ankle, and foot to make sure nothing else is injured.

Sometimes, a computed tomography (CT, or CAT) scan is done.  In some injuries, a magnetic resonance imaging (MRI) scan is ordered to look at the ligaments around the ankle.

Treatment

In some circumstances, non operative treatment is possible.  This is when the fracture is minimally or not displaced (the bones are still where they should be).  In these cases, the fracture can be protected with a number of different methods, ranging from a high-top tennis shoe to a short leg cast. The exact treatment required depends on a number of factors including the exact site of the fracture.  The surgeon will determine the most appropriate treatment.

Surgical Treatment

If the fracture is displaced or the ankle is unstable, surgery is required.  To make the ankle stable, a plate and screws on the side of the bone or a screw or rod inside the bone may be used to re-align the bone fragments and keep them together as they heal. Different wiring techniques may also be used.  Sometimes, the fracture can include “impaction,” or indenting of the ankle joint. This can require bone grafting to repair it, in order to lower any later risk of developing arthritis.

Repeat xrays will be required regularly to make sure the fracture does not change in position.

As with any surgery, there are risks.  General surgical risks include infection, bleeding, pain, blood clots in the leg, and damage to blood vessels, tendons or nerves.

Specific risks associated with the treatment of ankle fractures include difficulty with bone healing, arthritis, and pain from the plates and screws that are used to fix fracture. Some patients choose to have these removed several months after their fracture heals.