The ankle joint is made up of three bones: the tibia, fibula, and talus, which are connected to each other. The ends of the tibia and fibula, which are the bones in the lower leg, form the inner and outer malleolus. These are the bony parts of the ankle that can be seen and felt on either side of the ankle. The joint is covered by a fibrous membrane known as a joint capsule, and it contains synovial fluid, which helps the joint move smoothly.
Ankle injuries are common, especially among athletes and individuals engaged in physically demanding activities, often causing considerable pain and restricted mobility. Such pain may arise from a torn ligament, commonly referred to as an ankle sprain, or from a broken bone, known as an ankle fracture. An ankle fracture occurs when one or more bones forming the ankle joint break, leading to severe discomfort and difficulty in movement. The ankle joint depends on ligaments and soft tissues for stability, and these structures may also be compromised or damaged during an ankle fracture, further complicating the injury and recovery process.
Causes
Ankle fractures occur when the ankle twists, rolls, or bends excessively, usually due to accidents, falls, or high-impact activities such as jumping, which place sudden pressure and stress on the ankle joint, causing injury.
Symptoms
When someone has an ankle fracture, they usually experience immediate swelling and pain around the ankle, along with difficulty moving. In some instances, blood can collect around the joint, which is known as hemarthrosis. In more serious fractures, there is a noticeable deformity around the ankle joint, and in some cases, bone may even break 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.
- 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.
Diagnosis
The process of diagnosing an ankle injury begins with a physical examination, after which X-rays and a CT scan of the affected area are performed to get a clearer understanding. It is often challenging to tell the difference between a broken ankle and other issues like a sprain, dislocation, or tendon damage without an X-ray. In certain situations, pressure is applied to the ankle, and special X-rays are taken. This process is known as a stress test. The stress test helps assess the stability of the fracture and determines whether surgery is needed. In more complicated cases, where there is a need for a detailed evaluation of the ligaments, an MRI scan is recommended.
Treatments
Immediately after suffering an ankle injury and before visiting a doctor, it is important to apply ice packs and keep the foot raised to help reduce pain and swelling.
The method used to treat an ankle fracture varies based on the type of break and the stability of the bone. At first, treatment typically involves non-surgical methods. But if the fracture is unstable and the bones cannot be correctly realigned, surgery becomes required.
In non-surgical treatment, the ankle bone is gently adjusted back into its correct position, and supportive devices such as splints or a cast are placed around the joint. This support is usually maintained for a duration of at least two to three weeks.
In surgical treatment, an incision is made over the ankle to access the fractured bone. Metal plates are attached with screws to align and stabilize the broken parts. After securing the plates, the incision is closed with stitches. To ensure proper healing, the ankle is then supported and immobilized with a cast or splint.
Post-operative care
Following ankle surgery, you will be advised to refrain from placing weight on the affected ankle and will need to use crutches for walking for a minimum of six weeks.
The doctor will recommend physical therapy for the ankle joint. After completing 2 to 3 months of therapy, the patient should be able to resume their usual daily activities.
Risks and complications
Ankle fractures can lead to various risks and complications. If the cast is not applied correctly or the bones are not aligned properly, it may result in deformities and later develop into arthritis. In certain situations, pressure on the nerves can lead to nerve injury, causing intense pain.
Occasionally, surgery might not fully heal the broken bone, necessitating a second surgical procedure to fix the issue.
