Ankle Fractures

Ankle fractures are a break in one of several bones about the ankle. They can be fractures with our without dislocation.

Causes & Symptoms

Ankle fractures can occur at any age and can result from a high-energy twist, fall, or direct blow. In older people ankle fractures can result from a simple twist or fall.

Symptoms of an ankle fracture include pain, swelling, bruising, tenderness to touch, and inability to place weight on the leg. In the case of a fracture dislocation the ankle may look out of place.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays. Physical examination is done to ensure pulses, nerve function, swelling and skin integrity. If there is any bleeding around the fracture site this may be concerning for a skin puncture and this has an increased urgency as this can lead to increased risk of infection. Occasionally a CT scan is needed to evaluate more complex fractures.

Initial treatment initially includes reduction if needed and immobilization in a splint. Nonsurgical treatment reserved for those fractures where the fragments are not out of place or the ankle is not unstable. Occasionally a stress x-ray may be done to ensure ankle stability.

Surgical treatment is indicated if the fragments are not aligned or the ankle appears unstable. Surgical treatment is done plates and screws to hold the fragments in the correct position. Without fixation of displacement fragments, fractures may not heal or heal in a suboptimal position resulting in pain or the early development of arthritis. Typical treatment involves no weight bearing on the ankle for 6 weeks and possibly 12 weeks with unstable injuries. Return to driving is variable but averages 9 to 12 weeks from the time of injury.