1. This shows the anatomy of the shoulder joint.

640px-919_Ankle_Feet_Joints.jpg

1. This shows the ankle joint, with many of the bones and connecting ligaments.

640px-Ankle_fractures_1_--_Smart-Servier.png

2. This diagram shows an ankle fracture, with both the tibia and fibula fractured.

Carli_Lloyd_(48677254417).jpg

3. Competitive soccer athletes are particularly at risk for high ankle sprains, which are more severe ankle injuries resulting from high energy collisions. These ligament injuries often occur alongside fractures.

Fracture

What is an ankle fracture?

Ankle fractures occur when one or more of the bones in the ankle is broken, which are the tibia, fibula, and talus. Ligaments are commonly injured alongside fractures, creating the potential for instability and complications in the joint.

How are they caused?

Fractures of the bones of the ankle can be caused by twisting, tripping, falling, or high energy trauma like car accidents. They can also be caused by stress, particularly in an active person who decides to dramatically increase their activity. The elderly are also at risk for these injuries.

What are the types of ankle fractures?
  • The most common type of ankle fracture is to the side of the outermost leg bone (lateral malleolus of the ankle).

  •  In a bimalleolar fracture, the medial and lateral parts of the malleolus are fractured, whereas in a trimalleolar fracture all three parts of the malleolus are fractured. Bimalleolar fractures are often treated with six weeks of non weight bearing followed by six weeks of a removable brace while trimalleolar fractures are more unstable and likely require surgery.

  • Pilon fractures are fractures in the bottom of the sin bone (tibia) that are caused by high energy trauma. 

  • The back of the tibia (posterior malleolus fracture) is often fractured alongside other bones in the ankle. 

  • Syndesmosis injuries, also called high ankle sprains, are also usually accompanied by one or more fractures to the bones of the ankle. 

  • A Maisonneuve fracture is a simultaneous injury to the ligaments of the ankle accompanied by a fracture in the fibula.

 

However, broader classifications of ankle injuries include:

  • Nondisplaced ankle fractures: bones are broken but still in place

  • Displaced ankle fractures: bones are broken and out of place

What are the symptoms of this condition?

Ankle fractures are severely painful, and are even temporarily disabling as an individual cannot put weight on their joint. Swelling, tenderness, and even deformity as the joint is misaligned as the ankle joint is injured.

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Ligament Injuries

How is it treated?

Treatment for these injuries depends on instability and alignment, as even a slight degree of malalignment can lead to arthritis, especially if there are multiple bones broken. Ligament injuries often occur alongside ankle fractures, making these injuries and their treatment complex. Stable joints can be treated nonoperatively while unstable injuries may require surgery. 

 

It takes about six weeks for a broken bone to heal, so treatment for these injuries often includes about 4-6 weeks without weight bearing, though it depends on the fracture. Supports like sprints, casts, and removable braces are often used to recover from this injury. Patients should begin physical therapy and eventually strengthening exercises after this period of non weight bearing.

Postoperative Care for Surgery

Ankle injuries that create more instability may require surgery. After surgery, sutures are removed 10-14 days post op, before the patient is put in a boot. From here on they can slowly start moving the ankle and showering. X-rays are taken at six weeks, and then the patient can start weight bearing and physical therapy.

Sources
Attribution for Images

1. OpenStax College. "919 Ankle Feet Joints". Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:919_Ankle_Feet_Joints.jpg.

2.  Laboratoires Servier. “Ankle fractures 1 -- Smart-Servier”. Wikimedia Commons, 29 September 2019, 

https://commons.wikimedia.org/wiki/File:Ankle_fractures_1_--_Smart-Servier.png.

3. Lorie Shaull. “Carli Lloyd”. Wikimedia Commons, 4 September 2019. https://commons.wikimedia.org/wiki/File:Carli_Lloyd_(48677254417).jpg.

4. Chaim Mintz. “Trimalleolar Ankle Fracture”. Wikimedia Commons, February 1, 2017, https://commons.wikimedia.org/wiki/File:Trimalleolar_Ankle_Fracture.jpg.

5.  Whoisjohngalt. “Ankle brace for grade I or II”. Wikimedia Commons, July 16, 2016, https://commons.wikimedia.org/wiki/File:Ankle_brace_for_grade_I_or_II.jpg.

6. 3. Ssu. "Hoka One One". Wikimedia Commons, 22 June 2020, https://commons.wikimedia.org/wiki/File:Hoka_One_One_-_Bondi_6.jpg

Trimalleolar_Ankle_Fracture.jpg

4. This X-Ray shows a trimalleolar ankle fracture that was treated surgically with rods and pins.

Ankle_brace_for_grade_I_or_II.jpg

5. Braces can offer support to recover from ankle fractures.

Hoka_One_One_-_Bondi_6.jpg

6. These are Hokas, a brand of supportive shoe. Good shoes, especially good running shoes can help prevent future ankle injuries.