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Welcome to Orthopaedic Solutions & Sports Medicine Center, PA

Ankle Fractures (Broken Ankle)

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months. Broken ankles affect people of all ages.

Cause

  • Twisting or rotating your ankle

  • Rolling your ankle

  • Tripping or falling

  • Impact during a car accident

Doctor Examination

Medical History and Physical Examination

After discussing your medical history, symptoms, and how the injury occurred, Dr. Parikh and his team will do a careful examination of your ankle, foot, and lower leg.

Imaging Tests

If Dr. Parikh and his team suspects an ankle fracture, more tests may be needed to provide more information about your injury. X-rays. X-rays can show if the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of broken bone there are (CT) scan. It is useful when the fracture extends into the ankle joint. (MRI) scan.. For some ankle fractures, an MRI scan may be done to evaluate the ankle ligaments.

There are 5 Different types of Ankle Fractures

  • Lateral Malleolus Fracture

  • Medial Malleolus Fracture

  • Posterior Malleolus Fracture

  • Bimalleolar Fractures

  • Trimalleolar Fractures

Lateral Malleolus Fracture is a fracture of the fibula.

Treatment

Nonsurgical Treatment

You may not require surgery if your ankle is stable, meaning the broken bone is not out of place or just barely out of place. A stress x-ray may be done to see if the ankle is stable. The type of treatment required may also be based on where the bone is broken.

You will see Dr. Parikh and his team regularly to repeat your ankle x-rays to make sure the fragments of your fracture have not moved out of place during the healing process.

Surgical

During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

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.

Treatment

Nonsurgical Treatment

If the fracture is not out of place or is a very low fracture with very small pieces, it can be treated without surgery. A stress x-ray may be done to see if the fracture and ankle are stable.

The fracture may be treated with a short leg cast or a removable brace. Usually, you need to avoid putting weight on your leg for approximately 6 weeks.

You will need to see Dr. Parikh and his team regularly for repeat x-rays to make sure the fracture does not change in position.

Surgical

(Left) X-ray of a medial malleolus fracture. (Right) Surgical repair of a medial malleolus fracture with a plate and screws. 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 (called 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.

Posterior Malleolus Fracture

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

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

Treatment

Nonsurgical

If the fracture is not out place and the ankle is stable, it can be treated without surgery.

Treatment may be with a short leg cast or a removable brace. Patients are typically advised not to put any weight on the ankle for 6 weeks.

Surgical

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

Bimalleolar Fractures

Two of the three parts or malleoli of the ankle are broken. In most cases of bimalleolar fracture, the lateral malleolus and the medial malleolus are broken and the ankle is not stable.

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

Treatment

Nonsurgical

Immediate treatment typically includes a splint to immobilize the ankle until the swelling goes down. A short leg cast is then applied. You will need to see Dr. Parikh and his team regularly to repeat your x-rays to make sure your ankle remains stable.

In most cases, Weightbearing is not allowed for 6 weeks. After 6 weeks, the ankle may be protected by a removable brace as it continues to heal.

Surgical

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

Trimalleolar Fractures

Three malleoli of the ankle are broken. These are unstable injuries and they can be associated with a dislocation.

Treatment

Nonsurgical

These injuries are considered unstable and surgery is usually recommended.

Nonsurgical treatment is similar to bimalleolar fractures, as described above.

Surgical

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

It takes at least 6 weeks for the broken bones to heal. It may take longer for the involved ligaments and tendons to heal.

As mentioned above, Dr. Parikh and his team will most likely monitor the bone healing with repeated x-rays. This is typically done more often during the first 6 weeks if surgery is not chosen.

Although most people return to normal daily activities, except for sports, within 3 to 4 months, It may take several months for you to stop limping while you walk, and before you can return to sports at your previous competitive level. Most people return to driving within 9 to 12 weeks from the time they were injured.

Dr. Parikh and his team will help and schedule when to start moving your ankle, physical therapy and home exercise programs. Doing your exercises and compling with Dr. Parikh’s treatment plan is key to healing the fracture properly.

Eventually, you will also start doing strengthening exercises. It may take several months for the muscles around your ankle to get strong enough for you to walk without a limp and to return to your regular activities.

Again, exercises only make a difference if you actually do them.

Weightbearing

Your specific fracture determines when you can start putting weight on your ankle. Dr. Parikh and his team will work with you to start putting weight on your ankle when he or she feels your injury is stable enough to do so.

It is very important to not put weight on your ankle until your physician says you can. If you put weight on the injured ankle too early, the fracture fragments may move or your surgery may fail and you may have to start over.

Supports

It is very common to have several different kinds of things to wear on the injured ankle, depending on the injury.

Initially, most ankle fractures are placed in a splint to protect your ankle and allow for the swelling to go down. After that, you may be put into a cast or removable brace.

Even after the fracture has healed, Dr. Parikh and his team may recommend wearing an ankle brace for several months while you are doing sporting activities.

Complications

People who smoke, have diabetes, or are elderly are at a higher risk for complications after surgery, including problems with wound healing.

Treatment

Nonsurgical

Without surgery, there is a risk that the fracture will move out of place before it heals. This is why it is important to follow up with Dr. Parikh as scheduled.

If the fracture fragments do move out of place and the bones heal in that position, it is called a "malunion." Treatment for this is determined by how far out of place the bones are and how the stability of the ankle joint is affected.

If a malunion does occur or if your ankle becomes unstable after it heals, this can eventually lead to arthritis in your ankle.

Surgical

General surgical risks include:

  • Infection

  • Bleeding

  • Pain

  • Blood clots in your leg

  • Damage to blood vessels, tendons, or nerves Risks from the surgical treatment of ankle fractures include

  • Difficulty with bone healing

  • Arthritis

  • Pain from the plates and screws that are used to fix fracture. Some patients choose to have them removed several months after their fracture heals


Information obtain from www.orthoinfo.aaos.org

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