The ankle joint is composed of three bones: the tibia, fibula and talus, which articulate with each other. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule and filled with synovial fluid to enable smooth movement.
Ankle injuries are very common in athletes and people engaged in physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament, and is called ankle sprain, or from a broken bone, which is called ankle fracture. An ankle fracture is a painful condition, where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilised by different ligaments and other soft tissues, which may also be injured during an ankle fracture.
Ankle fractures result 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.
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 haemarthrosis. In the case of a severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin.
Types of fractures
Ankle fractures are classified according to the location and type of ankle bone involved. The different types of ankle fractures are:
- Lateral malleolus fracture, in which the lateral malleolus, the outer part of the ankle, is fractured
- Medial malleolus fracture, in which the medial malleolus, the inner part of the ankle, is fractured
- Posterior malleolus fracture, in which the posterior malleolus, the bony hump of the tibia, is fractured
- Bimalleolar fractures, in which both lateral and medial malleolus bones, are fractured
- Trimalleolar fractures, in which all three lateral, medial and posterior bones, are fractured
- Syndesmotic injury, also called a high ankle sprain, is usually not a fracture but can be treated as a fracture.
The diagnosis of the ankle injury starts with a physical examination, followed by X-rays and CT scan of the injured area for a detailed view. Usually, it is very difficult to differentiate a broken ankle from other conditions such as a sprain, dislocation or tendon injury without having an X-ray of the injured ankle. In some cases, pressure is applied on the ankle and then special X-rays are taken. This procedure is called a stress test. This test is employed to check the stability of the fracture, to decide if surgery is necessary or not. In complex cases, where a detailed evaluation of the ligaments is required, an MRI scan is recommended.
Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimise pain and swelling.
The treatment of ankle fracture depends upon the type and stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.
In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint for at least 2-3 weeks.
With surgical treatment, 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 fractured parts. The incision is then sutured closed, and the operated ankle is immobilised with a splint or cast.
After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.
Physiotherapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, you may be able to perform your normal daily activities.
Risks and complications
Risks and complications that can occur with ankle fractures include improper casting or alignment of the bones, which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain. Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery to repair.