What Is It?
A fracture is the term used to describe a break in the bone. Breaks usually result due to high energy or low energy injuries. A fracture that occurs due to a high energy injury is termed a traumatic fracture and is a result from a significant amount force. Low energy fractures are termed stress fractures and are a result from repeated exposure to low amounts of force. Fractures of the ankle can be a serious problem depending on the level of severity. The ankle joint is a very complex system and disruption of the joint from severe fractures can lead to joint instability. A joint, simply put, is a surface that is comprised of the ends of at least two bones (where the bone come together and meet), cartilage (which cushions our joints), tendons (which connects muscle to bone), and ligaments (which connects bone to bone). All work together to give our joints the ability to move. Any injury that disrupts this unity eliminates the joints ability to function properly.
The two main bones of the ankle are the tibia (long bone of the lower leg) and the talus (the ankle bone). The fibula also comprises the ankle joint, though the tibia and fibula make up it’s own joint as well, known as the syndesmosis joint. Both joints are held together by ligaments. In the gap between the tibia and talus is cartilage to cushion the joint during movement. The malleolus is the term used to describe the prominence on each side of the ankle (the bony bumps that you feel). This is comprised of the bones that make up the ankles and are classified into three regions. The lateral malleolus is comprised of the fibula and is located on the side of the foot away from the body. The medial malleolus is the inner side of the foot and is comprised of the tibia. The posterior malleolus is the back part of the tibia, so the side behind the body. Doctor’s classify fractures based on these regions and their level of severity.
Types of Fractures
Fractures of the ankle can come in many shapes and forms and can affect one or more of the bones that make up the ankle. A Bi or Trimalleolar fracture for example implies that two or three sections of the malleolus are fractured respectively. In addition, patients can have a non-displaced fracture or a displaced fracture. Non-displaced fractures imply that the fragments of bone that make up the fracture are intact, while displaced fractures mean that the fracture fragments are separated. Typically, breaks result in non-displaced fractures and can be treated conservatively by casting and wearing a boot. Healing time for conservative treatment is about a month. Displaced fractures can be more serious and run the risk of disrupting the anatomy of the ankle. Some serious high energy accidents can result in severe displacement fractures. In pediatric patients, displaced fractures also run the risk of disrupting the growth plate, causing growth arrest. For these types of injuries, surgical intervention is most likely necessary.
One of the more severe types of ankle fracture is the pilon fracture. Pilon is the French word for pestle, a tool used for grinding in labs and apothecaries. Here it is used to describe the damage done to the ankle during a high-energy accident (you might hear a pilon fracture called a high-energy ankle fracture). The talus acts like a jack hammer and grinds into the tibia. Shattering or splintering of all three ankle bones can result. Patients typically present with a pilon fracture after a motor vehicle accident or fall from a large height. Though a pilon fracture can be a serious injury, in some instances it could be treated conservatively.
For most displacement injuries, surgical correction will be needed. Surgery will require internal fixation (such as nails, screws, and plates) to reset the bones and to hold them in place while they heal. This is to realign the bones back to their normal anatomic position. Sometimes displaced bone fragments can heal improperly resulting in a deformity. Surgical correction and fixation will also be needed to correct any deformity that is present. It may possible to remove the hardware down the road, though this depends on the individual. Sometimes an individual can live comfortably with the hardware remaining in place.
Because of the wide range of injuries that could be present, recovery times can vary. Other factors like age, smoking, and medical conditions such as diabetes can also have an impact on healing. Patients will be expected to be non-weight bearing for several months after surgery. Casting and splinting may likely follow surgery to help further immobilize the joint and minimize movement while the bone heals. A non-weight bearing scooter is recommended. It could take as soon as six weeks for the bones to fuse together, but may take longer depending on the individual. Soft tissue structures such as ligaments will take longer to heal. Your doctor will instruct when to progress to partial and full weight bearing. It is essential to not put weight on your ankle until told to do so. Placing pressure on the joint too soon might shift the bones if they have not set yet. Two to three months is the typical time frame for progression to full weight bearing. Most individuals can expect to be back to regular activities such as work and driving after three months.
Physical therapy will be essential during the recovery period and beyond. It is important to train your foot and ankle in the months after healing is completed. Studies have shown that patients can still be in the recovery process for up to two years after surgery. This all depends on the extent of the injury. Some severe injuries like a pilon fracture could also limit the function of an individual even after healing is completed. Athletes for example may not be able to reach the full range of activity that they had before surgery. Again, this all depends on the individual and the extent of the injury. Your doctor and other healthcare professionals will help to assess and reach the level of activity that you will be able to obtain. Lastly, depending on the severity of the injury your ankle joint might see damage to the cartilage. This could lead to the onset of arthritis in the future. However, there are conservative and operative techniques that could be employed to take care of arthritis should symptoms arise.
Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.