Ankle Fracture - Causes, Symptoms, Diagnosis, and Treatment

Introduction

A broken ankle occurs when the bones constituting the ankle joint are broken. Fractures may range from a simple break in one bone to several fractures resulting in an individual not being able to put weight on it for a few weeks to several months. In other words, the number of broken bones is directly proportional to the instability of the ankle joint and several ligaments being damaged. They hold the ankle bones and joints in position. Ankle fractures affect people of all ages. However, several studies in the past 30 to 40 years indicate an increase in the number and severity of broken ankles.

What Are the Structural Components of the Ankle Joint?

The anatomy of the ankle joint consists of the following components:

• The bones.

• The ligaments.

• Muscle attachments.

Three bony components that constitute the ankle joint are as follows:

• Tibia - Colloquially known as the shinbone.

• Fibula - The smaller bone of the lower limb.

• Talus - A small bone present between the calcaneus, fibula, and tibia.

The specific parts of the shinbone and fibula constitute the joint as follows:

• Medial malleolus.

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• Posterior malleolus.

• Lateral malleolus.

The ligaments present in the ankle joint are as follows:

• Anterior tibiotalar ligament.

• Posterior tibiotalar ligament.

• Tibionavicular ligament.

• Tibiocalcaneal ligament.

The muscle attachments of the ankle joint are as follows:

• Gastrocnemius.

• Soleus.

• Plantaris.

What Are the Probable Risk Factors for Ankle Fractures?

Ankle fractures often happen when the foot lands on an uneven step, floor, playing field, or tilts. If the ankle does not get straightened in time, it can be severely twisted out of position, and the bones may fracture. In addition, the peroneal muscles running along the outer surface of the lower leg and across the ankle are responsible for supporting your ankle. If they are weak, your chances of fracturing or spraining an ankle increase.

How Are Ankle Fractures Classified?

Ankle fractures are classified according to the area of the fractured bone. For instance, when a fracture occurs at the end of the fibula, it is termed a lateral malleolus fracture. In contrast, if both the tibia and fibula are fractured, it is termed a bimalleolar fracture.

The joints involved in ankle fractures are as follows:

• Ankle joint.

• Syndesmosis joint.

What Are the Causes Behind Ankle Fractures?

• Twisting or rotating the ankle.

• The rolling motion of the ankle.

• Tripping or falling due to uneven steps.

• Impact during a car accident.

What Are the Signs and Symptoms of Ankle Fractures?

A sprain can feel the same as a broken ankle; thus, a competent physician should evaluate any injury.

The common symptoms of a fractured ankle include:

• Immediate and severe pain.

• Swelling.

• Bruising.

• Tender to touch.

• Cannot put any weight on the injured foot.

• Deformity ("out of place"), particularly if the ankle joint is dislocated as well.

How to Diagnose Ankle Fractures?

• X-rays: X-rays are required to determine whether there is a broken bone or a soft-tissue injury like a sprain or spasms, which have symptoms similar to ankle fractures.

• Computed Tomography (CT) Scans: In addition, radiographic imaging techniques such as computed tomography (CT) scans may be needed as adjuncts to determine the scope, extent, and damage caused by the injury.

• Magnetic Resonance Imaging (MRI): It reveals damage to the surrounding soft tissue.

If medical imaging studies show a fractured ankle, an orthopedic surgeon consultation is necessary as early as possible. Several variants of ankle fractures may not require any surgical interventions. However, a skilled foot and ankle specialist should address fractures that warrant surgery. An inappropriate or poorly executed surgery can lead a patient to require additional corrective surgeries, whether immediately or years later, which may lead to ankle instability, arthritis, or even require an ankle replacement procedure. Therefore, early diagnosis and prompt treatment are instrumental to preserving the ankle joint over the long term.

How Are Ankle Fractures Treated?

• The treatment of ankle fractures is based on the alignment of bones and the stability of the joint. The treatment goal is to heal the bones as close to perfect as possible to prevent residual instability or malalignment.

• As little as two millimeters of malalignment may lead to arthritis which is more challenging to treat than proper healing immediately after the initial diagnosis. Mild ankle breaks that are stable with no displacement can be treated non-surgically with splints, short-leg casts, or protective devices such as a removable boot.

• Some patients can walk immediately after the treatment while wearing support, while others may require the use of crutches to limit weight-bearing.

• For more severe fractures in which bones or bone fragments are misaligned, surgical intervention is necessary to prevent improper healing (malunion) that would impede proper movement in the ankle and possibly lead to other complications.

What Is the Expected Recovery Time Post Treatment?

• The bone takes about six weeks to heal, and it may take longer for ligaments or other soft tissues to heal.

• After surgery, patients are typically not weight-bearing for about four to six weeks until bone healing is satisfactory.

• A pain management protocol to minimize the need for opioid medications is advisable.

• The patients are in a splint, elevating the limb 90 % of the day for the first week or two. The sutures are removed around 10 to 14 days after the procedure, with patients typically placed into a removable boot allowing the patients to start moving the ankle and take showers. The sixth-week follow-up visit requires an X-ray evaluation to check the healing status.

• Patients can start weight-bearing alongside physical therapy if the bone is healed well, which is generally provided over six weeks or more if required.

Conclusion

Fractures may range from a simple break in one bone to several fractures resulting in an individual not putting weight on it for a few weeks to several months. X-rays are required to determine whether there is a broken bone or a soft-tissue injury like a sprain or spasms, which have symptoms similar to ankle fractures. In addition, radiographic imaging techniques such as a CT scan or MRI may be needed as adjuncts to determine the scope, extent, and damage caused by the injury. The treatment is based on the alignment of the bones and the stability of the ankle joint. The treatment goal is to heal the bones as close to perfect as possible to prevent residual instability or malalignment.

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