Ankle fractures are some of the most common fractures in the human body. It is often due to a sport injury, but can also be caused by minor twisting trauma, such as missing a step, or massive high-energy trauma such as motor vehicle accidents. 

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The diagnosis is made on patient history (trauma), physical examination (tenderness, swelling, bruising, deformity, wounds) and confirmed with X-Rays or CT scan.

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The immediate treatment involves immobilization in a splint, elevation of the injured limb, careful application of ice and analgesia.

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Definitive treatment should provide bone healing in the anatomic (normal) position. In most cases this necessitate surgery. While the patient is under anaesthesia, the surgeon reduces the displaced bone fragments back to the anatomic position and keep them in place with plates and screws. In some cases, ruptured ligaments are also repaired.

 

If the injury is associated with an open wound on the same limb segment, it is being regarded as a compound fracture - an orthopaedic emergency! This type of injury needs admission to hospital and administration of antibiotics and tetanus prophylaxis, followed by surgical care, as soon as possible!

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After surgery, the patient will be in a back slab - a soft bandage with a hard shell behind the leg and ankle. The operated limb should be elevated as much as possible to reduce pain and swelling and improve surgical wound healing. Walking is allowed with crutches or other walking aids, without putting pressure on the operated limb and should only include short distances in the house.

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After 10 to 14 days the patient should follow up with the surgeon for wound inspection, removal of sutures, application of a cast or protective boot, and referral to physiotherapy.

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Further standard follow-up visits are usually scheduled at 6 weeks post-op and then every 6 weeks until the fracture has healed and the patient regained good function again.

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If a screw/screws were inserted between the tibia and fibula to stabilize a syndesmosis injury, it should be removed in theater at 4 months post-op.

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Ankle fractures may lead to long term pain, stiffness and swelling in the ankle joint, known as post traumatic ankle arthritis. Proper treatment of acute ankle fractures is the best way of reducing this risk. 

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