You have had an ankle fracture (both or one tibia & fibula)? Looking for reliable and comprehensive information on the topic?
Based on my experience as a diagnostic radiographer and thorough exploration of scientific literature, I have put together this article for you.
Happy reading!😊
(Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article? Your input is greatly appreciated?) 🙏
Written by Juliet Semakula, a diagnostic radiographer
💁Disclaimer: no affiliate links.
A broken ankle is a fracture or multiple fractures of one or more of the three bones in the ankle joint.
A bit of anatomy! Promise you just a tiny bit:
The ankle joint is composed of the three bones:
🟤Tibia
🟤Fibula
🟤Talus
In between we have the ligaments for example (deltoid) found in the inner part of the ankle which provides most of the stability.
You can also damage these ligaments when you have a fracture or sprains on the ankle causing instability.
▶️What are different types of ankle fractures?
Because the ankle joint comprises three bones, there are numerous types of ankle fractures. I will list the most common types.
1️⃣ Lateral malleolus fracture: It is a break of the lateral malleolus, on the outside of the ankle (in the lower portion of the fibula).
2️⃣Bimalleolar ankle fracture: It involves breaks of both the lateral malleolus and of the medial malleolus. The inside of the ankle (in the lower portion of the tibia).
3️⃣Tri malleolar ankle fracture: This type involves breaks in three sides of the ankle: the medial malleolus, the lateral malleolus and distal (lower portion) of the posterior malleolus of the tibia.
4️⃣A plafond fracture: This is a fracture through the weight bearing “roof” of the ankle (the central portion of the lower tibia).
Within each of the above types, the fracture could be either.
🟩 Nondisplaced – Bones are broken but still in correct position and alignment.
🟩 Displaced – Fractured portions of bone are separated or misaligned.
▶️How do you tell if you broke your ankle?
All ankle fractures share common symptoms of:
⏺️Pain and swelling either of which may be present only in the ankle region itself or spread to parts of the foot or up toward the knee.
⏺️Any pain will usually be more intense if you try to put weight on the ankle or to walk.
⏺️Bruising
⏺️Deformity of the bone in the foot or ankle
⚠️Caution⚠️! All these symptoms may not necessarily be present at the same time.
You will have x-rays taken to confirm if you have broken your ankle.
So how do you determine if you have really fractured your ankle and not something else?
Your doctor conducts examinations (often an X-ray) to rule out other causes of pain.
If there is a fracture and the doctor thinks you might need surgery an MRI OR CT scan will be requested because these scans provide a better view of the fracture and other associated soft tissue and ligament damage.
▶️What causes an ankle to fracture or break?
Ankle fractures can be caused by various modes of trauma for example:
🤸Falls or rotational injury: Most people who come to x-ray they claim to have had a fall running during sports or walking and twisting their ankle.
🧗Road accidents or jumping from heights.
▶️What to do in case of an ankle fracture?
Treatment options:
Treatment will be based on how bad your ankle is fractured and how best to align the bones and the stability of the ankle joint.
The goal is to have the bones heal as closely to perfect as possible to prevent any residual instability or malalignment of the bone.
A malalignment of as little as two millimetres in the ankle joint can lead to arthritis. It is much easier to fix a fracture than to treat arthritis in the future.
▶️Short term non-surgical treatment options
If your fracture is not displaced and stable, it can be treated non surgically with conservative methods such as:
♦️ A short leg plaster cast allows for early immobilisation of the ankle joint for several weeks while the bone heals.
♦️Walking boot (functional bracing)
‘’Some patients may be able to walk immediately while wearing a support while others may have to use crutches to limit weight bearing.’’
▶️Advantages and disadvantages of a cast
There may be a decreased risk of developing deep vein thrombosis due to immobilisation.
A cast provides maximum support however there are possible complications of wearing a cast.
💠Extended time off work and development of post-traumatic arthritis
💠There is the risk associated with prolonged immobilisation such as muscle atrophy, deep vein thrombosis and joint stiffness.
💠The long-term consequences, include prolonged gait abnormalities.
💠Persistent calf muscle weakness and an inability to return to previous activity levels.
Both a splint and cast seem to do the same job
Functional bracing may address the above issues. However, it does not provide the same degree of support to the healing bones. (Kearney,2017).
There is minimal evidence supporting the use of functional bracing overcast immobilisation to improve functional outcome, range of motion, swelling, or post-traumatic arthrosis after ankle fracture in the long term.
Other studies analysing outcomes after cast immobilisation of ankle fractures found that prolonged periods of immobilisation are associated with a significant degree of patient osteopenia and osteoporosis and decrease in bone mineral density and a decrease in bone mineral content immediately after cast removal at 6 weeks. (Ceroni .et. al,2012).
This should not worry you, the end goal is get your ankle functioning again, and all these are possible complications it does not mean it will happen to you.
▶️Surgery option: Ankle fracture.
When your fracture is unstable, defined by a disruption of the tibiofibular syndesmosis and medial deltoid ligament, which leads to displacement of the talus, surgical intervention is necessary to prevent improper healing (malunion) that would impede proper movement.
The definitive treatment for ankle fractures is open reduction and internal fixation (ORIF) of the ankle.
Surgery images: Ankle fracture.
Plate and screw fixation of the distal tibia and fibular is demonstrated with significant reduction in fracture displacement when compared with previous.
➡ ️ Possible complications of surgery treatment of ankle fractures.
🩸Infection
🩸Post -traumatic arthritis superficial wound problems
🩸Later complications non-union and malunions.
▶️What is the recovery time of a broken ankle?
By recovery: Are we talking about how long it takes for the bone segments to be correctly realigned?
Or are we talking about when all the potential injuries associated with the dislocation are healed and you can walk again?
Here’s a rough estimate, based on my experience with patients and some empirical data.
1️⃣Your fractured ankle will be supported by a brace or cast after immediate treatment to maintain reduction while healing.
2️⃣Support usually takes 6 weeks of immobilisation in a below-the-knee plaster or fibreglass cast.
3️⃣It takes about six weeks for bones to heal. It may take longer for ligaments or other soft tissues to heal as well.
4️⃣After surgery, patients are typically not weight bearing for 4 to 6 weeks until the bone heals.
5️⃣ Patients are placed on a pain management protocol that minimises their need for opioid medications. For the first couple of weeks, patients are in a splint and are elevating the limb 90% of the day.
6️⃣After 10 to 14 days, the sutures are removed, and patients are typically placed into a removable boot. This allows patients to start moving the ankle and to shower.
7️⃣At the six-week visit, X-rays are obtained. Assuming the bone is healed well, patients are then allowed to start weight bearing and to begin physical therapy. Patients will generally have six weeks of therapy or more if required.
⚠️ caution⚠️! If you are in a cast or a brace, most likely you will not be performing exercises for your ankle.
After your fractured ankle has healed, your doctor will remove the cast and allow you to bear more weight on your ankle.
You may be using an assistive device like crutches to walk.
▶️Rehabilitation of ankle fractures (physical therapy)
Once your fracture is reduced and immobilised, you may be referred to a physical therapy to help you understand your weight-bearing restrictions.
A physical therapist will help you begin with a range of motion exercises by manoeuvring your ankle at first.
Then you will begin simple exercises on your own such as pointing your toes and moving your foot in and out.
These may be slightly painful as you get used to moving the joint again, but it should not be severe or lasting pain.
Gentle exercise for the muscles of the knee and hip may be performed to ensure that the muscle groups that help you walk do not get too weak while the fracture heals
You should also remember everyone heals differently, and everyone’s ankle fracture injury is different.so discuss any concerns with your doctor.
In general, physical therapy for a broken ankle lasts about 6 to 8 weeks. Your personal experience with physio may be shorter or longer depending on your specific injury.
There is limited evidence supporting early commencement of weight-bearing and the use of a removable type of immobilisation to allow exercise during the immobilisation period after surgical fixation.
Because of the potential increased risk of adverse events, the patient’s ability to comply with the use of a removable type of immobilisation to enable controlled exercise is essential.
There is little evidence for rehabilitation interventions during the immobilisation period after conservative orthopaedic management and no evidence for stretching, manual therapy or exercise compared to usual care following the immobilisation period.
Small, single studies showed that some electrotherapy modalities may be beneficial. More clinical trials that are well-designed and adequately powered are required to strengthen current evidence. (Lin, 2012)
There is no medical, surgical, natural, or physical therapy treatment that can directly speed up the healing time of your ankle fracture.
Your body does this quite well on its own. However, you can facilitate the natural healing and consolidation process by not hindering it.
Here are some suggestions:
✅ Limit smoking and alcohol as these substances can slow down consolidation.
✅ Try to stay active as possible! E.g., swimming and walking because physical activities stimulate bone cells to produce new cells, accelerating blood circulation to help bone healing.
✅If you are above 55 years old in winter countries, consider taking vitamin D and calcium supplements because sun exposure is very limited. Of course, consult your doctor before you think of taking any medication to see if it is fit for you.
You’ve reached the end of this article about ankle fractures. I hope I’ve answered a few of your main questions.
Any more questions, leave in the comments section. I will be glad to answer you .Wishing you a smooth recovery and a return to your regular activities! 😊
Below are the sources of articles I have relied on to answer your questions ,of course with my own experience as a diagnostic radiographer.
📚Sources:
Ceroni D, Martin X, Delhumeau C, Rizzoli R, Kaelin A, FarpourLambert N. Effects of cast-mediated immobilisation on bone mineral mass at various sites in adolescents with lower-extremity fracture. J Bone Joint Surg Am. 2012;94(3):208–216. 10
Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976;58(3):356–357.
Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev. 2012 Nov 14;11:CD005595. doi: 10.1002/14651858.CD005595.pub3. PMID: 23152232.
McPhail SM, Dunstan J, Canning J, et al. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord 2012;13:224.
Kearney RS, Parsons N, Mistry D, et al. A protocol for a feasibility randomised controlled trial to assess the difference between functional bracing and plaster cast for the treatment of ankle fractures. Pilot Feasibility Study 2017;3:11.
Kearney RS, Parsons N, Mistry D, et al. A protocol for a feasibility randomised controlled trial to assess the difference between functional bracing and plaster cast for the treatment of ankle fractures. Pilot Feasibility Study 2017;3:11.