What is an ankle fracture?

A fracture is the partial or complete breakage of a bone. At the ankle, fractures affect the distal or distal ends of the tibia, fibula, or both bones. The tibia is the tap bone and is located on the inner, or middle, side of the leg. The fibula is located on the outer, or lateral, side of the leg. The distal ends of the tibia and fibula bones are also known as the medial and lateral malleolus, respectively.

Some distal tibial fractures can affect the back or back of the bone, also known as posterior malleolar fractures. Ankle fractures can range from less serious avulsion injuries (small pieces of bone that were removed) to dramatic severe fractures. Some fractures may also involve injury to major ankle ligaments that keep the ankle in its normal position. Ankle fractures usually occur when the ankle is twisted inward or outward.

One or all of the following signs and symptoms may occur with an ankle fracture:

• Pain at the fracture site, which can extend from the foot to the knee.

• Swelling that may appear along the leg or be more localized at the ankle.

• Blisters may appear over the fractured area. An orthopedic foot and ankle surgeon should treat these symptoms immediately.

• Appearance of bruising.

• Decreased ability to walk. If the fracture is less severe, it is possible to walk or bear weight on the ankle. Never rely on testing whether you can walk to determine if the ankle is fractured.

• Bones protrude through the skin. This condition is known as an exposed ankle fracture. These types of ankle fractures require immediate treatment to avoid problems, such as infection.

Most patients with ankle fractures are treated in an emergency room or in a doctor's office. An x-ray of the damaged ankle may be taken to determine the appearance of the fracture, what bones have broken and how far apart or displaced they are, as well as to find out the condition of the bone itself. The x-ray will help determine treatment.

Elevation and placement of ice

Swelling is usually seen after an ankle fracture. If the amount of swelling is limited, pain from the ankle fracture can be lessened and additional damage to the surrounding soft tissue prevented. Elevation of the ankle and placement of ice on the affected area may help limit swelling.

Splinting

A splint may be needed to support the broken ankle. The splint should usually be worn for several days. The splint leaves room for the swelling to settle in. If the damaged ankle is not displaced, the splint can be applied immediately without moving the broken ankle. However, if the bones are displaced or the ankle joint is dislocated, a closed reduction is performed while the splint is placed. This treatment involves arranging the bones of the tibia or fibula and ankle joint to improve position and decrease ankle pain. This treatment may require some form of anesthesia.

Resting / Not Bearing Weight

Most patients must rest for a certain period of time without supporting weight with the ankle. Crutches, walkers, and wheelchairs allow patients to avoid putting weight on the ankle. Many factors can determine which is the best option for a particular patient. The type of ankle fracture will determine when patients can begin to stand and walk with an injured ankle. In many cases, the patient cannot put weight on the ankle for several days, weeks, or even months. This determination should be made by the foot and ankle orthopedic specialist.

Immobilization with fracture plaster cast/orthopedic boot

Some ankle fractures can be treated without surgery. These are usually injuries in which a bone moves minimally. Such fractures can simply be treated with a period of immobilization. Once the initial swelling improves with the first few days, a cast or an orthopedic fracture boot may be applied to the ankle in order to protect it and immobilize it properly. Both the cast and the boot can provide adequate protection for the ankle. The cast cannot be wetted or removed without the aid of special tools. The boot can be removed for bathing and sleeping. The type of fracture and the doctor's judgment will determine the best type of immobilization. The cast or boot should be worn until the fracture heals completely, which usually takes two to three months.

Surgery

Whether or not a patient needs surgery depends largely on the appearance of the ankle joint on x-ray and on the specific type of fracture. Fractures with wide displacement and fractures of the tibia and fibula usually require surgery. Restoring the alignment of the broken bone is essential for complete recovery because if a fracture does not heal properly, ankle arthritis can develop. The best way to reduce the risk of arthritis is to restore the ankle to the normal position as much as possible.

The case

A 42-year-old male patient arrives in the emergency after a motorcycle accident with severe trauma to the left ankle, so he immediately goes to the emergency brought by a rescue team with an open wound.

Once we did the x-rays our team noticed a large fracture accompanied by a dislocation of the ankle, on the one hand it was important for the level of the injury determine if there was involvement of the main arteries, so it was indicated to perform a vascular doppler echo where it was evident that the pulse is present.

Once in the operating room we decided to perform the placement of an ankle stabilization system in open fractures, called Delta type fixator, because of the D shape it has after assembly. The idea of this device is to maintain a proper alignment until a next surgery.

But we had a drawback, the great instability of the ankle was compromised by a fracture of the inner side of the tibia (medial malleolus fracture), so we decided to perform for the type of fracture a different reduction called: Obenque. This procedure is a little difficult but fortunately it was a success after we saw the final X-rays.

We hope soon after his wound heals to operate on this patient in a next opportunity to remove the fixator type Delta and place the definitive material, we have managed to keep safe the stability of his ankle and expect the best results.