Ankle Fractures Causes, Symptoms, and Treatment

Ankle injuries are among the most common of the bone injuries. An ankle fracture is also known as a broken ankle. These types of fractures occur when one or more of the ankle joint bones separate into pieces. It is typical for the ankle ligaments to be damaged with an ankle injury. The types of ankle fractures and injury we cover include lateral malleolus fracture, medial malleolus fracture, posterior malleolus fracture, bimalleolar fracture, and trimalleolar fracture.

Ankle Anatomy

The ankle consists of three bones that come together: the tibia (shin bone), the fibula (small lower leg bone), and the talus (a foot bone). The medial malleolus is the inner portion of the tibia. The posterior malleolus is the back portion of the tibia. The lateral malleolus is the end of the fibula. The syndesmosis is the joint between the fibula and tibia, which connects together with ligaments.

Cause of Broken Ankles

Broken ankles occur in all age groups. They come about when there is twisting or rotating of the ankle during a fall or impact of a car accident. Many refer to this type of injury as a “rolled” ankle.

Symptoms of a Broken Ankle

A severe ankle sprain feels the same as a broken ankle. Common complaints include immediate, severe pain, bruising, tenderness to the touch, swelling, inability to bear weight, and a deformity of the ankle. For severe ankle fractures, the bone may protrude through the skin.

Diagnosis

Because it is difficult to tell a sprain from a fracture, our orthopedic specialists recommend an evaluation by x-ray. Depending upon the type of fracture the surgeon finds, he may order a “stress x-ray” for further evaluation. In some cases, the surgeon orders a computed tomography (CAT scan) or magnetic resonance imaging (MRI) for further evaluation.

Lateral Malleolus Fracture Treatment

A lateral malleolus fracture is a fracture of the fibula bone. Since there are different levels at which the fibula can be injured, the treatment depends on the severity.

Nonsurgical Treatment – When lateral malleolus fractures are not out of place, the surgeon will treat these without surgery. The surgeon places you in a short leg cast or other device for protection. Depending on the injury, you will not be able to put weight on the affected leg for 4 to 6 weeks, meaning you will have to use crutches.

Surgical Treatment – For lateral malleolus fractures that are out of place, the orthopedic specialist will perform surgery on the injury. To make the ankle stable, he uses a plate and screws or screws and a rod. These attach to the bone fragments to realign the fibula so it can heal properly.

Medial Malleolus Fracture Treatment

A medial malleolus fracture can also involve injury to the fibula, the posterior malleolus, and the ankle ligaments. Just like the lateral types, the orthopedic specialist treats medial malleolus fractures according to their severity.

Nonsurgical Treatment – If the fracture is in alignment, it can be treated without surgery. The doctor put you in a removable brace or short leg cast to be worn for 4 to 6 weeks. The doctor recommends crutches also for a period of time.

Surgical Treatment – The surgeon will perform a procedure if the medial malleolus fracture is unstable and out of alignment. If the injury includes impaction of the ankle joint (damage to the cartilage surfaces), the surgeon will sometimes apply bone graft to repair it and decrease later risk of arthritis development. Many different techniques are used for this type of surgery.

Posterior Malleolus Fracture Treatment

A posterior malleolus fracture is a break in the back of the shinbone near the ankle joint. These types of fractures often include ligament damage. Many times with a posterior malleolus fracture, a lateral malleolus injury occurs.

Nonsurgical Treatment – Like other ankle fractures, fractures that are in alignment can often be treated conservatively without surgery. The orthopedic specialist will place you in a short leg cast or other device and recommend crutches for 4 to 6 weeks.

Surgical Treatment – Surgery is necessary when the bones are not in proper position, and the break is serious. The surgeon can use screws and plates along the back area of the shinbone to hold the bones in place while they heal.

Bimalleolar Fracture Treatment

“Bi” simply means two. When fractures are bimalleolar, this means that two or more parts of the malleoli of the ankle are involved. These injuries typically involve the lateral malleolus and the media malleolus. Bimalleolar fractures are not stable, as they are also often associated with ligament damage. Many times, there is a break of the fibula along with other structure damage.

Nonsurgical Treatment – Bimalleolar fractures require surgery. However, if you have significant health problems, the surgeon will not operate and recommend conservative treatment. The doctor uses a splint or short leg cast to stabilize and protect the injury. Also, you will not be able to bear weight on the ankle for 4 to 6 weeks.

Surgical Treatment – Because of the complexity of these types of fractures, the orthopedic specialist may combine surgical techniques in order to repair the various structures. Often times, a plate and screws are used to align bone fragments. Also, it may be necessary for the surgeon to use bone graft in bimalleolar fractures.

Trimalleolar Fracture Treatment

“Tri” means three. Trimalleolar injuries involve all three malleoli of the ankle. These types of fractures are unstable injuries and dislocation is common.

Nonsurgical Treatment – Unless you are in considerable poor health, the orthopedic specialist will recommend surgery for trimalleolar fractures. However, if you cannot undergo surgery, the surgeon will place your lower leg in a cast or removable device for stabilization and place you on crutches.

Surgical Treatment – These types of fractures are complex and require a combination of surgical efforts for repair. The surgeon will often use plates and screws, bone grafting, and other techniques during the procedure. Because dislocation is common, the doctor will have to properly align the bone and ligaments.

Clavicle Fracture

The collarbone is also called the clavicle. A fracture to this bone is a common injury that occurs in people of all ages. Most breaks to the clavicle occur in the middle portion. The clavicle is located between the ribcage and the shoulder blade. This structure connects the arm to the trunk of the body and lies above several important blood vessels and nerves. These vital body components do not usually become injured with a clavicle fracture.

What causes clavicle fractures?

The collarbone gets broken when there is a direct blow to the shoulder. This can occur during a fall onto the shoulder or during a motor vehicle accident. A fall onto an outstretched arm can also lead to a fracture of the clavicle. Many infants are born with a fracture to the collarbone – an injury that occurs during a traumatic birth.

What are the symptoms of a clavicle fracture?

If you sustain a clavicle fracture, it will most likely be very painful and hard to move your arm. Other symptoms include:

• Shoulder sagging downward and forward
• A deformity or “bump” over the area of the break
• Inability to lift the arm without pain
• Bruising, swelling, or tenderness over the clavicle
• A grinding sensation when the arm is raised up

How is a clavicle fracture treated?

With some breaks, the ends of the bone have not shifted out of place and line up correctly. These types of fractures do not require surgery, and the orthopedic specialist can treat them with conservative measures.

These include the use of an arm support or sling (worn to keep the arm in proper position while the bone heals), mild pain medication, and physical therapy. Therapy is done to increase muscle strength in your shoulder and to prevent stiffness and weakness of the muscles.

The orthopedic specialist will recommend surgery if the bones are displaced (out of place) and do not line up correctly. During the procedure, the bone fragments are situated into their normal alignment and held that way with special screws and plates that are attached to the outer surface of the bone.

These structures are not removed until after the bone has healed. Some surgeons use pins to hold the fracture in proper position once the bone ends are put back in alignment.

AC Separation

The acromioclavicular joint (also called the AC joint) is the area where the clavicle meets the highest point of the shoulder blade. An injury to this structure that is common is an AC separation, where a force causes the ligaments that attach to the underside of the clavicle to tear.

What causes an AC separation?

The most common reason for a person to suffer an AC separation is a fall directly onto the shoulder. The force causes the ligaments to be injured and the collarbone separates from the wingbone (shoulder blade). This type of injury will cause the wingbone to move downward with the weight of the arm, creating a bulge above the shoulder.

How is an AC separation treated?

If the shoulder is not seriously deformed, and the AC separation is mild, the orthopedic specialist will recommend nonsurgical treatment modalities. These include the use of a sling, cold packs, and pain medications. Most people will return to full activity once the injury has healed without permanent, significant deformity.

If the pain of AC separation persists with conservative treatment, or the tears to the ligaments are severe, the orthopedic specialist will recommend surgery. This is done to trim back the end of the clavicle so that it will not rub against the shoulder blade. This procedure can be done long after the injury has occurred, too.

Joint Dislocations

A dislocation is an injury to a joint in which the ends of the bones are forced out of their normal positions. Joints are the areas of the body where two or more bones come together. This particular kind of injury temporarily immobilizes and deforms the joint and results in severe, sudden pain.

Dislocations can happen to your shoulder, hip, knee, elbow, ankle, finger, thumb, or toe. If you suspect you have a dislocated joint, seek prompt medical attention. The orthopedic specialist will have to return the joint to its normal alignment.

What do I do if I think I have a dislocated joint?

It is difficult to distinguish a dislocated bone from a broken bone. If you suspect you have a dislocation or a broken bone, there are things you can do while you are waiting to see the doctor. While you are waiting for medical attention:

• Don’t move the joint. Sling or splint the affected area in its current position. Do not try to force the joint back into place. This could damage the bones, muscles, ligaments, nerves, and blood vessels.
• Ice the injured area. Apply ice to the injured joint to reduce swelling, control pain, decrease the buildup of fluid, and stop internal bleeding.

What causes a dislocation?

The most common cause among young people is sports injuries. Dislocations can occur during contact sporting activities, such as hockey or football. They can also occur with falls during sports, such as gymnastics, volleyball, downhill skiing, or snowboarding. Basketball and football players frequently dislocated the joints of the fingers or hands when striking the ball or during a fall. Also, any fall or hard blow to a joint can result in a dislocation, such as a motor vehicle accident.

What are the complications of a joint dislocation?

There are many serious complications with a dislocated joint. These include:

• Nerve or blood vessel damage
• Tearing of ligaments, tendons, and muscles
• Development of arthritis
• Susceptibility to re-injury

How is a dislocated joint treated?

Besides ordering X-rays and MRIs, the treatment of your dislocation may include:

Reduction – This is the process where the orthopedic specialist gently maneuvers the joint to put the bones back into proper position. You will be given an anesthetic or pain reliever prior to this procedure.
Immobilization – Once the doctor has your bones back in the right place, he will immobilize your joint with a sling or split for several weeks. This is done to allow the area to heal and protect it from further injury. How long you will wear the device will depend on the severity of your injury.
Pain Medication – After the doctor does the reduction, your pain will subside. However, if your pain continues, you may be prescribed a mild pain reliever or muscle relaxant.
Surgery – If there is damage to the nerves or blood vessels or if the doctor cannot move your dislocated bones back into position, surgery may be necessary. The orthopedic specialist often recommends surgery if you have recurring dislocations.
Rehabilitation – Once your sling or splint is removed, you will begin a rehabilitation program to help restore your joint’s strength and range of motion. Most dislocations take several months to heal.

What can I do to help heal my dislocated joint?

There are several things you can do to help encourage healing and ease discomfort. These include:

Use ice and heat. Applying ice to your injured joint helps reduce pain and inflammation. You can use a cold pack or a towel filled with ice cubes for 20 minutes at a time. Do this every couple of hours while you are awake. Also, hot packs or a heating pad helps relax sore, tight muscles. Limit heat applications to 15 minutes at a time and do these every couple of hours.

Rest the joint. You don’t want to repeat the activity that caused the injury in the first place. Also, avoid painful movements of the injured joint.

Take a pain reliever. Use your pain medication as prescribed. The orthopedic specialist will suggest an anti-inflammatory agent, such as naproxen (Aleve) or ibuprofen (Motrin). Follow the label directions and stop using the drug when the pain improves.

Maintain the range of motion in your joint. After a few days, do some gently range of motion exercises approved by your doctor or physical therapist. This helps to restore strength to the joint and maintain range of motion.

What can I do to prevent future dislocations?

To prevent further or future dislocations:

Take precautions to avoid falls. Make sure your vision is good by getting your eyes checked. If you take medications that make you dizzy, avoid standing up too fast. Also, keep your home well-lit and remove tripping hazards from walkways.

Wear protective gear. If you play contact sports, wear devices that protect your joints.

Follow doctor’s orders. While you are recovering, follow your doctor’s orders. To avoid recurrence, do the recommended stability and strengthening exercises.

Arthroscopy FAQs

Arthroscopy is a detailed surgical procedure that allows your orthopedic specialist to look at the inside of a particular joint through a viewing instrument called an arthroscope. During this procedure, the doctor looks at the joint surfaces, as well as the other structures within the joint, such as the cartilage and ligaments. An arthroscopic examination allows the doctor to make a tiny incision in your skin and insert a pencil-sized instrument. The arthroscope has a small lens and lighting system used to illuminate and magnify the joint structures. The doctor can then visualize your joint on a TV monitor.

What does the word ‘arthroscopy’ mean?

The word ‘arthroscopy’ is derived from two separate Greek words, ‘arthro’ meaning joint, and ‘skopein’ meaning to look in. The term literally means “to look in the joint”.

Why is arthroscopy necessary?

The orthopedic specialist uses arthroscopy for diagnosis and repair. Some injuries can be diagnosed with x-rays, magnetic resonance imaging (MRI), or computed tomography (CT). Other injuries, however, require further diagnostic techniques. The arthroscope allows the surgeon to make a more accurate final diagnosis and repair the injury at the same time. Some of the common conditions found during arthroscopy include:

• Inflammation: Swelling and redness of the lining of the shoulder, elbow, wrist, knee, or ankle
• Shoulder: Injury to the rotator cuff tendon, injury to the biceps tendon, impingement syndrome, and recurrent dislocations
• Knee: Meniscus tears, chondromalacia, and anterior cruciate ligament tears as well as evaluating damage to the joint surfaces
• Wrist: Torn cartilage or loose bodies
• Loose Bodies of Bone or Cartilage

What are some problems treated with arthroscopy?

The problems treated with arthroscopy include:

• Reconstruction of the anterior cruciate ligament of the knee
• Rotator cuff surgery
• Removal of lose bone or cartilage
• Repair of torn ligaments
• Removal of inflamed synovium lining of the shoulder, knee, elbow, ankle, or wrist
• Repair or removal of a torn meniscus of the knee

What joints are most frequently examined by arthroscopy?

There are six joints that are typically examined with the arthroscope. These include the knee, shoulder, elbow, ankle, hip, and wrist.

How is arthroscopy performed?

Arthroscopic surgery is less traumatic than traditional open surgery. The orthopedic specialist uses general or regional anesthesia, depending on which joint and the extent of the problem. A small, buttonhole sized incision is made on the skin to insert the arthroscope along with several other small incisions around the joint area.

The surgeon inserts the instruments through this incisions and uses the additional incisions to insert specially designed instruments used for repair. When indicated, the surgeon corrects the problem and repairs the damage as necessary.

After the procedure, the small incisions are closed with sutures or Steri-strips and covered with a dressing. You will be moved from the operating room to the recovery room. Most arthroscopic procedures are done on an outpatient basis.

Before you are discharged to home, you will be given instructions about how to care for your wounds, what activities to avoid, and which exercises to perform to aid your recovery. The sutures will be removed during your follow-up visit.

What are the possible complications of arthroscopy?

Although complications are rare, they do occasionally occur following arthroscopy. These include blood clots of a vein, infection, excessive swelling, bleeding, damage to blood vessels or nerves, and muscle damage.

What are the advantages of arthroscopy?

Arthroscopic surgery allows quicker recovery time and less pain because less muscle and tissue are disturbed during the procedure, as compared to traditional open surgery. Most patients are treated as outpatients and are home several hours after the operation.

What is recovery like after arthroscopy?

The small incisions take several days to heal. The orthopedic specialist will instruct you as to when the surgical dressing can be removed. The pain in the joint is minimal but may take several weeks to maximally recover. The orthopedic specialist will develop a tailored rehabilitation plan for you to follow. This will depend on the joint that was worked on, the degree and severity of your injury or condition, and your current health status. Most athletes are able to return to their usual athletic activities within a few weeks, and other patients return to normal activities in a short time.

How does arthroscopy feel?

If you are given a general anesthetic, you will be unconscious and not feel anything during your operation. If you receive regional anesthesia, your arm or leg will be numb for several hours. You will not feel anything during the procedure either.

Expect to have some mild soreness and pain following your arthroscopic procedure. The orthopedic specialist will prescribe some pain medicine for you to use, and advise you to apply ice to your joint. This helps reduce pain and swelling. Be sure to keep your bandages clean and dry while the joint heals.