The ends of these bones are called malleoli. The tibia has a medial (inside) malleoli and a posterior malleoli. The fibula forms the lateral (outside) malleoli.
A broken ankle (ankle fracture) occurs when the malleoli are broken.
These fractures are very common. Ankle fractures happen with twisting of the ankle, falls, car accidents, or other injury. One, two, or all three malleoli can be broken. Ankle fractures can be displaced (out of place) or non-displaced. Symptoms
of an ankle fracture include pain especially with weight bearing, swelling, bruising, and problems with ankle motion. X-rays help determine if treatment from a foot and ankle orthopaedic surgeon is needed.
The main goal of ankle fracture surgery is to put the ankle joint back in place and to stabilize the bones to heal. Getting the ankle joint back in place helps to decrease the risk of developing arthritis of the ankle. Stabilizing the ankle with plates and screws may allow earlier motion.
When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. In some cases, the bones of the ankle may poke through the skin. These are called open ankle fractures and require surgery.
Ankle fracture surgery is not needed if the ankle is in proper alignment and stable despite the fracture. Surgery may be too risky when patients have a severe medical condition
Surgical treatment of ankle fractures allows patients to regain ankle function while the bones and joint heal. Immediately after surgery, your ankle will be immobilized for a few weeks. You will not be able to put weight on your ankle during this time and may use crutches, a knee scooter, or a wheelchair to get around. A shower chair or bench may be helpful to keep weight off your leg in the shower.
Once the wounds are healed, you will be fitted for either a cast
or a boot. Many surgeons use a removable boot. The boot protects the ankle as it heals but can be removed to allow washing, wound checks, and icing.
Once the broken bones start to heal, you will be told when you can put weight on the ankle in your cast or boot. You are then allowed to wean out of the cast or boot. You can progress to normal activities once the bones are fully healed. Some patients
may need physical therapy for their ankle to regain full movement and strength. While everyone is different, it may take up to a year after surgery for some patients to regain ankle function.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Potential long-term problems after ankle fracture surgery include ankle joint stiffness, weakness, and arthritis. Possible complications include infection and problems with healing. Factors that increase risks after ankle fracture surgery include diabetes,
steroid use, and nicotine use (cigarette smoking or smokeless tobacco).
Will my ankle hardware (plate and/or screws) have to be removed at some point?
Plates and screws used to fix an ankle fracture are not removed if they are not causing problems. Most people do not have problems with the plate and
screws. In rare cases, the plate and screws can cause some pain or irritation. When this happens, the hardware may be removed after the fracture is healed, about a year from the original surgery.
Original article by David Levine, MD
Contributors/Reviewers: Jamal Ahmad, MD; Naomi Shields, MD; Michael Greaser, MD
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