Ankle > Ankle Fractures

What are Ankle Fractures?

An ankle fracture is defined as a break of any of the bones in the ankle. The most common fracture is to the bony prominence on the outside of your ankle, called the lateral malleolus. This bony prominence is the bottom of your smaller lower leg bone, the fibula. The bony prominence on the inside of your ankle, called the medial malleolus, is less commonly fractured. Ankle fractures fall into two categories: nondisplaced and displaced. In nondisplaced fractures, there is a crack in the bone but the joint retains its normal structure; your anklebone (talus) remains between the shinbone (tibia) and the smaller lower leg bone (fibula). In a displaced fracture, fractured anklebones are severely displaced and the ankle joint is dislocated. Fortunately, most ankle fractures occur without a dislocation.


The usual cause of an ankle fracture in an athlete is an unexpected change in the way the foot makes contact with ground or floor. When you step on someone’s foot, or on an object, or on an uneven place on the turf or floor, your foot can tilt. Before you have time to react, your ankle can severely twist out of position and the bones can crack. Poor muscle strength can also contribute to ankle fractures. The peroneal muscles that run along the outside of your lower leg and cross the ankle, are responsible for bringing your ankle out to the side, which prevents your ankle from inverting or turning inward. People who lack proper peroneal muscle strength may have an inability to respond to the environment or to keep the foot and leg in an appropriate position when an unexpected twist occurs.


If left untreated, an ankle fracture can be dangerous to the stability of your ankle. The bones can move further out of position, and the pain can intensify and hinder your movement. For less severe fractures when the bones have not moved out of position and your ankle is not dislocated, a cast is the common method of care. Fractures are treated in a cast when you are not at risk of later instability. The most common type of ankle fracture treated in a cast is a fracture to your smaller lower bone (fibula) that is not associated with other fractures or an ankle dislocation. You may be a candidate for surgery depending on how far displaced your bones are because of the fracture. Fractures in the bony knobs on the sides of your ankles, called the medial and lateral malleolus, often need to be fixed back into position with screws or pins. The more severe the ankle fracture, the more likely you are to need surgical treatment.

Orthopedic Evaluation [top]

Though many people with mild or moderate ankle pain may believe they can treat themselves at home, you should have your ankle evaluated by a physician, who can check for complications and decide on a specific treatment program for your ankle. There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.


Your physician likely will ask about your activities, which may have caused your ankle fracture. You will probably be asked when the soreness or pain began. If you have had any prior ankle injuries, your physician will ask about the treatments you have tried in the past. You should reveal any relevant ankle surgery history at this time. Physicians generally suspect a less severe fracture when patients have a history of swelling and pain in their ankles that affects them during activity and has not improved despite previous treatment. Severe ankle fractures, on the other hand, usually can be diagnosed immediately after the injury. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.


During the physical exam, a physician typically looks for swelling and tenderness when your ankle bones are pressed upon. Physicians usually use their fingers to press areas all around your ankle to see if there are any tender spots or bumps in the bones. Your ankle may be moved up, down, side-to-side, and rotated to see if any positions are more painful.


X-rays usually are ordered first to see whether your anklebones have been fractured. X-rays can show cracks in the bones and bone chips on the bone surface. MRI (magnetic resonance imaging) tests may be needed to create images of your cartilage and any associated soft tissue damage to ligaments or tendons. CT (computerized tomography) tests may be needed to get a clear picture of your bone structure. These pictures may reveal fractures missed by X-rays.


Imaging techniques

Open Reduction, Internal Fixation

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