An ankle fracture refers to the breaking of one or more bones within the ankle joint. Fractures can vary in severity, ranging from a single fracture that doesn’t necessarily prevent walking to multiple fractures that may require surgical intervention.
Fractures can cause significant mobility and lifestyle difficulties. Individuals unable to support their weight on an injured ankle, for example, may be limited in their ability to walk, drive, play sports or fulfill work responsibilities.
Fractured ankles can be classified based on the degree to which the bone is displaced from its normal position:
An ankle fracture is accompanied by intense pain and additional symptoms like swelling, bruising, tenderness to touch, and an inability to put weight on the injured foot. Deformity, numbness, and coolness in the foot can also occur.
Ankle fractures can result from various activities, but are often sustained due to:
The treatment approach for an ankle fracture depends on the charscter of the break. These include:
Non-displaced fracture: this refers to a break where the bone fragments maintain alignment and normal position. In this case, a short leg cast or walking boot (aka moon boot) may be used to support recovery. Periodic x-ray will allow monitoring of the recovery process. Weightbearing may be restricted for several weeks.
Medial malleolus fracture: this refers to the lower part of the shinbone and often accompany fractures in other parts of the ankle. In this case, a short leg cast or walking boot may also be used to support recovery, alongside icing, compression and elevation.
Lateral malleolus fracture : this refers to fracture at the lower end of the fibula and can be treated in the same manner as any medial malleolus fracture. It may be possible to weightbear without significant discomfort.
Posterior malleolus fracture: this refers to fracture of the lateral malleolus, at the outside of the ankle. It too can be treated using a short case or walking boot, alongside icing, compression and elevation. This type of fracture tends to be stable, and so weightbearing may continue if tolerated.
Bimalleolar fracture and bimalleolar equivalent fracture : this refers to injury of the tibia and fibula which meet in the lower leg. If stable, a bimalleolar fracture may require immobilisation using a cast, which will limit weightbearing. X-ray will be used to monitor recovery and alignment.
Trimalleolar fracture: this refers to a fracture in the posterior malleolus as well as the two main parts of the joint. This can cause instability and joint dislocation, though the bones may heal and realign without surgery. If this doesn’t occur, surgery will be neccessary.
Syndesmosis injury: syndesmosis refers to a group of ligaments that stabilise the small joint located between fibula and tibia. Inuries here are often referred to as high ankle sprains and typically do not require surgery.
As with non-surgical treatment, surgical options for the treatment of ankle fracture vary based on the character of the injury. They include:
Medial malleolus fracture: where misaligned, surgical treatment involves If your medial malleolus fracture is misaligned, surgery may be necessary for realignment using one or two screws. In more severe cases where the fracture extends into the ankle joint, a plate and screws may be used for stabilisation.
Lateral malleolus fracture: where displaced, the fracture will be repaired using a plate and screws.
Posterior malleolus fracture: where the fracture is large and misaligned, screws are placed in the lower tibia, from front to back, to facilitate proper healing.
Bimalleolar fracture and bimalleolar equivalent fracture : surgery involves use of a plate and screws to stabilise the fracture. Bimalleolar equivalent fracture involves ligament damage on the inside of the ankle, resulting in a bone break and potential partial ankle dislocation. Here, it is neccessary to reposition the joint and restore the bone.
Trimalleolar fracture: surgical intervention is necessary where the bones fail to realign with conservative treatment.
Syndesmosis injury: where the injury involves a fracture and a ligamentous sprain, plate and screws are neccessary for stabilisation and repair.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
Need an urgent appointment? No problem.
Need X-rays? X-ray facilities available at all clinic locations
Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.