Ankle Fractures

Ankle Fracture Overview

Ankle injuries are among the most common of the bone and joint injuries. Often, the degree of pain, the inability to walk, or concern that a bone may be broken is what might cause you to seek care in an emergency situation.

For the most part, your concern is the same as the doctor's: Is there a broken bone? It is often impossible to diagnose a fracture (broken bone) rather than a sprain, a dislocation, or tendon injury without X-rays of the ankle.

  • The ankle joint is made up of 3 bones coming together.

    • The tibia, which is the main bone of the lower leg, makes up the medial, or inside, anklebone.
    • The fibula is a smaller bone that parallels the tibia in the lower leg and makes up the lateral, or outside, anklebone.
    • The far ends of both the tibia and fibula are known as the malleoli (singular is malleolus). Together they form an arch that sits on top of the talus, one of the bones in the foot.
  • These 3 bones (tibia, fibula, and talus) make up the bony elements of the ankle joint.
  • A fibrous membrane called the joint capsule, lined with a smoother layer called the synovium, encases the joint architecture. The joint capsule contains the synovial fluid produced by the synovium. The synovial fluid allows for smooth movement of the joint surfaces.

  • The ankle joint is stabilized by several ligaments, which are fibers that hold these bones in place.

Ankle Fracture Causes

When you stress an ankle joint beyond the strength of its elements, you injure the joint.

  • If only the ligaments give way and tear, you have sprained the ankle.
  • If a bone gives way and breaks, you have an ankle fracture.
  • Fractures can occur with simultaneous tears of the ligaments. You can do this in several ways:

    • Rolling the ankle in or out
    • Twisting the ankle side to side
    • Flexing or extending the joint
    • Applying severe force to the joint by coming straight down on it as in jumping from a high level

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Ankle Fracture Symptoms

Signs and symptoms of ankle injuries and fractures tend to be obvious.

  • Pain is the most common complaint.

    • Often the pain will not come from the exact area of the fracture.
    • You may experience associated fractures of your foot (especially on the side of the small toe) or knee that also cause pain.
    • It is usually pain in the ankle that stops you from walking.
  • Swelling frequently occurs around the ankle too.

    • Swelling suggests either soft tissue damage with possible blood around the joint or fluid within the joint itself, most likely blood.
    • When blood is in the joint, it is called hemarthrosis.
  • You may see bruising ("black and blue") about the joint, although not immediately. This bruising can track down toward the sole of your foot or toward the toes.

  • In severe fractures you may see obvious deformities of bones around the ankle.

    • Your skin may be stretched over an underlying broken bone.
    • You may see actual exposed bone.
  • If you injure nerves or blood vessels that supply your foot, you may experience even more pain along with pale skin in the foot, numbness, or inability to move your foot or toes.

When to Seek Medical Care

When you have injured an ankle, there several things you can look for to determine whether or not you need to see your doctor or go to an emergency department. The following situations warrant seeing your doctor as soon as possible:

  • You cannot bear weight on the ankle.
  • Your pain remains intolerable despite using over-the-counter pain medications.
  • Home care fails to reduce your pain.

If you are unable to see your doctor and have any of the signs or symptoms of an ankle fracture, you should go to an emergency department as soon as possible.

The following signs and symptoms call for immediate care at an emergency department:

  • Gross deformity of the ankle bones
  • Bones visible outside your skin
  • Intolerable pain despite over-the-counter pain medications
  • Inability to move your toes
  • Inability to move your ankle at all
  • Ankle numbness or partial numbness
  • Cold or blue foot

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Exams and Tests

When a doctor evaluates your ankle, the main task is to determine if you have fractured a bone or if the joint has been damaged sufficiently to have become unstable. Joint instability often suggests multiple fractures, a fracture with a ligament injury, or sometimes ligament injury alone.

  • The doctor will seek a history of the injury and will ask the following. These questions are important because different mechanisms of injury are associated with different fracture patterns.

    • Where does it hurt now?
    • How long ago did your injury happen?
    • Does your knee, shin, or foot hurt also?
    • How did the injury happen?
    • Did your ankle turn in or out?
    • Did you hear a crack or a pop?
    • Were you able to walk immediately after the injury?
    • Can you walk now?
    • Do you have any new numbness or tingling in your leg, ankle, or foot?
    • Have you had previous ankle fractures, sprains, or surgeries?

  • The doctor will perform a physical exam, looking at or for the following:

    • Evidence of bruising, abrasions, or cuts
    • Swelling, bleeding, and tissue damage
    • Pain, deformities, and the grinding or movement of broken bones of the knee, shin, ankle, and foot
    • Pain, excess looseness of a joint, or complete tear in ligaments
    • Fluid in the joint and joint stability
    • Pulse and evidence of injured blood vessels
    • Sensation and movement in both your ankle and foot

If the doctor suspects a broken bone, he or she will ask for ankle X-rays. The doctor may also ask for X-rays of your knee, shin, or foot, depending on where the pain is.

Ankle Fracture Treatment Self-Care at Home

If you suspect a fracture, you should call your doctor or go to a hospital's emergency department immediately. You can do the following until you can get to a hospital or doctor's office:

  • Stay off the injured ankle so you do not injure it further.
  • Keep the ankle elevated to help decrease swelling and pain.
  • Apply cold packs to the injured area to decrease swelling and pain. Do not apply ice directly. Cold packs are effective for the first 12-24 hours.

Ibuprofen (Advil, , Motrin) may be ideal for ankle injuries because it acts as both a pain medicine and a medicine to keep inflammation down. But check with your doctor first if you have any medical problems or take any other medicines or supplements.

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Medical Treatment

If surgery is not required, the type of fracture and the stability of your joint will determine the type of splint or cast that will be used and how long it will need to be in place.

  • If your bones are not aligned properly, the doctor may realign them before placing the splint or cast.

    • If the bones cannot be realigned properly in the emergency department, then you may require an operation.
    • An operation will also be needed if any bone has broken through the skin. If the bone breaks through the skin, the fracture is then called a compound fracture. This is more serious than a simple fracture.

  • Some minor ankle fractures do not require a splint or cast. In these cases the fracture will be managed as an ankle sprain.

    • Because these fractures are very small, they typically heal well with this management.
    • With any injured ankle, however, you should not bear weight until your doctor says it is OK to do so.

  • After the swelling decreases and you are reexamined, then an orthopedic doctor or your primary care doctor may place a better-fitting cast or splint on the ankle. Depending on the type of fracture, you may be placed in a walking cast, which can bear some weight, or you may still need a non-weight-bearing cast that will require the use of crutches to help you walk.

  • Depending on the degree of pain you are experiencing, your doctor may give you prescription-strength pain medication. These should be used only as needed. You should not drive or operate heavy machinery while using these medications.

Next Steps Follow-up

Follow-up care for an ankle fracture depends on the severity of the fracture.

  • You may need emergency surgery, next-day follow-up, or follow-up in 1-2 weeks with an orthopedic doctor.

  • You may require only follow-up with your family doctor.

    • If you were splinted on your initial visit, you will probably need to have a cast placed on your ankle during your follow-up visit.
    • The average fracture requires 4-8 weeks for the bone to heal.

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Prevention

Preventing ankle fractures can be difficult.

  • Many occur as "slip and fall" incidents. Being careful in your activities is the best prevention.
  • Proper footwear when participating in sports also may reduce your risk.

Outlook

Most simple fractures heal well with immobilization and non-weight-bearing activity.

  • You can expect most ankle fractures depending on how severe they are, to take 4-8 weeks for the bones to heal completely and up to several months to regain full use and range of motion of the joint.
  • More severe fractures, especially those requiring surgical repair, will take longer to heal.
  • Fractures of any type increase your likelihood of developing arthritis in the affected joint. The more severe the fracture, the higher the risk of developing some degree of arthritis.

Synonyms and Keywords

fractured ankle, broken ankle, sprained ankle, ankle fracture

WebMD Medical Reference from eMedicineHealth Reviewed by Melinda Ratini, DO, MS on May 04, 2014

Sources

Authors and Editors

Author: Stephen J Wolf, MD, Staff Physician, Department of Emergency Medicine, Denver Health Medical Center.



Coauthor(s): Erik D Barton, MD, MS, Associate Director, Assistant Professor, Department of Surgery, Division of Emergency Medicine, University of Utah Health Sciences Center.



Editors: Steven C Gabaeff, MD, FAAEM, Attending Physician, Emergency Medicine, Sutter Amador Hospital, Jackson, CA; Expert Consultant, Medical Board of California, Sacramento, CA; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.

 

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