Ankle Fractures

Who do Ankle Fractures Affect?

An ankle fracture can happen at any age. However, people who engage in extreme sports such as parkour or ice skating, which puts extra strain on the ankle joints are more likely to suffer this injury. 

The number of cases and the severity of fractures has increased in the past 40 years, due to a rise in an elderly population which is very active, making them more prone to experience this injury. 

How do Ankle Fractures Occur?

The ankle joint is made of three bones (tibia, fibula, talus) that articulate together. If there an unnatural force applied on the joint, it can result in fracture of one or more bones of the joint, resulting in ankle fracture.

Causes of Ankle Fractures

Ankle fractures occur from excessive rolling and twisting of the ankle, usually occurring from an accident or activities such as jumping or falling causing sudden stress to the joint. 

Road traffic accidents are another cause of ankle fractures.

Types of Ankle Fractures

Ankle fractures are classified according to the location and type of ankle bone involved. The different types of ankle fractures are:

• Lateral Malleolus fractures (outer part of ankle)
• Medial Malleolus fracture (inner part of ankle)
• Posterior Malleolus fracture (back part of ankle)
• Bimalleolar fractures (both inner and outer parts of ankle)
• Trimalleolar fractures (all three parts of ankle)
• Syndesmotic injury, also called a high ankle sprain, where the important ligaments between the tibia and fibula are injured
  

Symptoms of Ankle Fractures

With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases, blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin

How are Ankle Fractures Diagnosed

Medical History

Your doctor will ask questions about:

• Current symptoms and their severity
• If an injury was sustained
• Your medical history including family or genetic links
• Your current and past medications
• The impact of the problem on your occupation and lifestyle

Physical Examination

Your doctor perform comprehensive physical evaluation that will include:

• Examining the affected area for swelling, pain, bruising or other features
• Assessing your range of motion, walking pattern and other relevant features

Diagnostic Testing

Once your doctor has completed the physical examination further tests maybe required. These tests can help your doctor determine or eliminate possible causes. These can include:

• X-Ray
• Ultrasound (US)
• Computerised Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Once a final diagnosis has been completed your doctor can discuss with you and recommend any treatment options.

Non Surgical Treatment for Ankle Fractures

Treatment depends on the type of fracture sustained. For mild fractures, nonsurgical treatment is advised and includes

• Rest: Resting the affected area or pausing athletic activity until the symptoms have reduced
• Pain medication - Paracetamol or Nonsteroidal anti-inflammatory medications (NSAIDs) can relieve some pain or discomfort
• Acute injuries may require R.I.C.E.
• Rest: Rest the affected area as more damage could result from putting pressure on the injury.
• Ice: Ice should be applied over a towel to the affected area for 15-20 minutes every two to three hours during the day.
• Compression: Wrapping with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling and provide support to the injured area.
• Elevation: Elevating the injured area above heart level will also help with swelling and pain.
• Plaster or Boot: You may require a plaster/fibreglass cast or walking boot help support your ankle whilst the fracture heals
• Physiotherapy: A physical therapist / physiotherapist may recommend exercise training and bracing to strengthen the area of pain and reduce the symptoms. This process commonly involves having a patient engage in a series of helpful exercises.

Surgical Treatment for Ankle Fractures

In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint.

In cases where either a conservative treatment has not resolved the problem or where the fracture pattern is such that conservative treatment will fail, the only option is surgery. This may include:

• Internal fixation: The fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone, to realign and stabilise the fracture.
• External Fixation: Using Pins, wires and frames which sit outside the ankle and stabilise the fracture. This is typically reserved for more complex injuries or if the soft tissues are swollen or injured.

What if Ankle Fractures are Untreated?

If left untreated, the broken ankle joint and its associated pain will render a person unable to walk and can lead to further damage to surrounding tissue and ligaments, including life-threatening infections if the fracture is of an open nature. 

Improper alignment of the bones in the absence of proper medical care can also cause deformities and eventually arthritis. Pressure on the nerves can result in nerve damage and permanent pain.