Ankle Fracture – Overview

Fractured Ankle PainThe fractured ankle is a common ankle injury and requires appropriate evaluation and treatment by a specialist. These are classified as one, two or three part fractures. The more parts involved, the more unstable the fracture and the more likely that surgery will be recommended for the patient.

Closed ankle fractures need to be reduced or “set” in order to align the bones, restore proper blood flow, allow for swelling to resolve and take pressure off of the skin. This is often performed in the ER or in the office.

Open fractures require hospital admission and prompt irrigation of the wound in the ER followed by repeat irrigation in the OR with reduction of the fracture and antibiotics which are begun in the ER.

Cause of Ankle Fractures

Ankle Fractures are most often the result of a rotational injury to the ankle. These ankle injuries are commonly associated with sporting activities and falls. A pilon fracture is a special type of crush injury to the weight-bearing surface of the ankle joint and is usually associated with high velocity injuries such as falling from a height greater than 10 feet or motor vehicle accidents.

Signs and Symptoms of the Fractured Ankle

  • Pain
  • Swelling
  • Bruising
  • Deformity of the ankle or foot
  • Numbness and/or tingling
  • Inability to bear weight or move the ankle
  • Breaks in the skin, coolness or paleness of the foot are more ominous signs/symptoms of the fractured ankle.

Diagnostic Testing

X-rays are needed to identify a fracture. If reduction is performed, x-rays should be repeated after the splint is applied to ensure the reduction is satisfactory. A CT scan is sometimes needed to evaluate complex fractures and is used to plan for surgical repair.

Treatment of an Ankle Fracture

This type of ankle injury is treated by reduction of the Fractured Ankle Surgery Recoveryfracture to improve bony alignment. Isolated fibula fractures are often further evaluated by stress x-rays to assess the degree of instability in determining whether or not surgery is necessary.

Two and three part ankle fractures are unstable by nature and almost always require surgery, unless the patient did not walk prior to the ankle fracture for some reason. The timing of surgery is dictated by the amount of swelling and fracture blisters must be resolved prior to the operation.

Both conservative and surgical treatment involves immobilization in a cast or boot and a period of non weight-bearing before weight-bearing in a boot is allowed. Diabetic ankle fractures are not treated the same as in a non diabetic patient. Diabetic ankle fractures require more rigid surgical fixation, longer periods of non weight-bearing and the surgical hardware is left in place indefinitely in most of these patients.