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Ankle Fracture

The Condition

Patients are often confused by the words break and fracture. These words are synonymous and mean the exact same thing. A fracture of the ankle can involve any of the three bones associated with the ankle joint: the talus, tibia or fibula. The tibia and/or fibula are the most commonly affected when ankle fractures occur. These injuries can vary in severity from a small simple avulsion fracture to an open (or compound) fracture where bone actually breaks the overlying skin. Open ankle fractures subject the bones and soft tissue to a greater chance of infection.

The Treatment

Immediate evaluation by a foot and ankle surgeon is imperative. If one is not available then the fracture should be evaluated by an emergency room physician. At your appointment the physician will likely take X-rays and may even ask for more advanced imaging studies such as a CT scan or an MRI. Your doctor will examine your foot and ankle for pain and deformity. Neurovascular status will also be evaluated to ensure that your blood vessels and nerves have not been compromised following your injury. Once your evaluation is complete, the initial treatment will consist of R.I.C.E:

  • Rest: Staying off of the injured ankle to reduce the risk of further injury
  • Ice: Applying ice to the area for 10-15 minutes per hour while awake will help reduce pain and swelling
  • Compression: An elastic bandage like an ACE wrap may be used to help control swelling
  • Elevation: Keeping the injured limb elevated at or above the level of your heart will help lessen swelling and the throbbing that may occur after the injury

After your physician has thoroughly assessed the extent of the ankle injury, they may recommend one of several definitive treatment plans. Simple fractures may be amenable to walking in a protective cast boot (cam walker) for several weeks, while a badly displaced fracture may require surgical care. Your physician will likely immobilize your ankle in a splint/cast or cast boot at your initial visit.

Frequently Asked Questions

First and foremost, your foot and ankle surgeon will have a detailed discussion with you regarding the risks and benefits of the surgery. If surgery is recommended it is usually because the displacement of the bones or the location of the fracture will have a higher chance of healing properly if it is relocated and fixed into place with a plate and/or screws.

As with any surgery that involves cutting of skin, there is a chance of infection. That chance increases in the presence of an open fracture, but typically the risk of infection with this type of surgery is extremely low – less than 1% in most instances. Any time a fracture involves a joint surface the risk for post-injury arthritis increases. If this does occur, additional treatment may be needed.

The most common risks are pain and swelling after operation, which can be controlled by following your physician’s instructions. In addition, delayed or non-union of the bony structures can occur. Hardware failure (screws and plates) can occur but is not typical and usually the fixation does not require removal.

Recovery time can vary from patient to patient based on other health conditions (i.e. diabetes and tobacco use/abuse). Typically after surgery you can expect to be non-weight bearing for a period of 6-12 weeks depending on the severity of the fracture and the treatment required as well as your overall health status. Your doctor may recommend crutches, a walker, a wheel chair, or even a knee scooter to aid in mobility.

The answer is: it depends. Most of the time patients do extremely well and return to their normal activities of daily living post fracture/surgery. The type of fracture sustained also determines your activity level post fracture/surgery. Your physician will work with you to help you regain as much mobility and function of your ankle as possible. This may require physical therapy, but will likely require time and patience on your part.