Ankle fracture

An ankle fracture refers to a broken ankle. There may be tiny cracks in bones, simple fracture in one bone or multiple fractures. A simple break may not stop you from walking but multiple fractures makes the ankle unstable requiring not to put weight on the fractured leg for few months.

The bones that form the ankle joint are: tibia, fibula, and talus. Tibia is present on the inner, medial side of the leg. Fibula is located on the outer, lateral side of the leg. The distal ends of the tibia and fibula are medial and lateral malleoli, respectively. The ligaments keep the ankle bones in position.

Symptoms of a broken ankle

Symptoms and signs of a broken ankle include:

  • Throbbing pain and ankle swelling

  • Blisters and bruising over the fractured area

  • Difficulty or abnormality in motion

  • A crack sound during the injury

  • Visible bones through the skin (in case of open fracture)

  • Dislocated joint

Complications

Complications due to ankle fractures are rarely seen. If there is an open fracture, risk of bone infections (osteomyelitis) increase. Due to fracture, the adjacent nerves and blood vessels get damaged.

Causes and risk factors

Ankle fracture is a common injury and it can occur due to accidents, falls, twisting or rotating the ankle, applying force on the joint while jumping from heights.

Participating in high-impact sports such as running and jumping is a risk factor as the bone is overused. Due to this, stress fractures can occur. Wearing improper shoes, conditions such as osteoporosis and neuropathy also increase the risk of ankle fractures.

The diagnosis begins with review of medical history and a physical examination. During physical examination, your doctor checks the areas of tenderness to determine the precise location, determines range of motion and gait, skin sensation, and other symptoms such as swelling and deformity.

Your doctor may recommend imaging tests to determine condition of bone, type of bone fractured, and the extent of dislocation.

X-ray:Mostly, ankle and foot fractures are diagnosed through X-ray. The test is performed to determine whether the bone is broken or displaced, and if the bone is broken, how many broken pieces are present.

Bone scan:A radioactive material is injected into the vein during the bone scan. Damaged areas appear as spot on the image obtained after the scan. Stress fractures are diagnosed using this test.

Stress test:a special x-ray, called stress test is taken by your doctor by keeping pressure on the injured ankle. This test helps to determine the requirement of surgery.

Computed tomography (CT) scan:This scan helps in further evaluation of injury such as extension of fracture into the ankle joint

Magnetic resonance imaging (MRI) scan: This scan uses strong magnetic field to give images of bones and ligaments with high resolution. The scan identifies fractures that are not visible in an x-ray image.

If you suspect that your bone is fractured, immediately consult your doctor. You may be referred to an orthopedic doctor. You can try few measures before you reach doctor’s office or emergency department. Apply cold-packs and keep the ankle elevated to reduce swelling and pain.

Medications

Over-the-counter medications such as ibuprofen, naproxe, or acetaminophen can be prescribed by your doctor to treat pain.

Reduction

If the fracture is displaced, your doctor realign the bone through the process called reduction. A muscle relaxant or local anesthetic will be given during the process to manipulate the pieces into proper positions.

Use of splints of casts

The broken bone is immobilized with the help of cast to protect and support the bone until it heals. Pressure sores may occur sometimes due to use of cast. If there is swelling and the fracture is minor, your doctor prefers splint as they provide space to accommodate swelling.

If your doctor uses cast, you need to follow some measures to avoid complications:

  • Keep the cast clean and dry.

  • Wrap the cast with a plastic bag before taking a shower.

  • Don’t scratch the skin under the cast.

  • Don’t remove the cast by yourself.

Surgery

Your doctor prefers surgery in some cases to maintain proper position of bone until it heals. During surgery, the surgeon uses pins, plates, or screws and these are removed when the bone completely heals.

Physical therapy

After healing, your doctor recommends a physical therapist to teach exercises for improving flexibility and strength of the joint, and restoring normal range of motion.

Following few measures can prevent ankle fracture:

  • Wear proper shoes and replace athletic shoes regularly.

  • Consume calcium-rich foods such as milk and yoghurt to improve bone strength.

  • Exercise regularly to strengthen the ankle muscles.