An ankle fracture, also known as an ankle dislocation fracture, is one of the most common types of fractures. Ankle fractures are often caused by the foot twisting or rolling under while the rest of the body remains stationary.
For more information on ankle fractures and their treatment, please see the text below. You will also find a list of selected experts in the treatment of ankle fractures here.
Definition and Causes of the Fracture
The ankle joint bears the weight of the entire body when walking. It consists of the medial and lateral malleoli, as well as what is known as Volkmann’s triangle.
In addition to this bony framework, various ligaments—especially the anterior and posterior syndesmotic ligaments—are important for the stability of the ankle joint. If these ligaments tear, the ankle joint is no longer stable and can wear out quickly.
An ankle fracture, or what is known as an ankle dislocation fracture, is one of the most common types of fractures. It is often caused by the foot twisting or rolling under the body while the rest of the body remains stationary. Depending on the circumstances, different types of ankle fractures can occur.
Doctors often classify ankle fractures according to the Weber classification into types Weber A, B, and C. This classification is based on the location of the fracture in relation to the syndesmosis—that is, the ligamentous connection between the tibia and fibula. If the fracture is below the syndesmosis, it is classified as a Weber A fracture; at the level of the syndesmosis, it is a Weber B fracture; and above the syndesmosis, it is a Weber C fracture. This classification helps to better assess the instability of the ankle joint and the need for surgical treatment.
The bones and ligaments of the ankle joint © bilderzwerg / Fotolia
Symptoms and Diagnosis of an Ankle Fracture
A dislocated ankle fracture can often be diagnosed during a physical examination. Typically, an X-ray of the affected foot is then taken to assess the exact extent of the fracture and identify any displacement of the bones. If the findings are unclear or if additional ligament injuries in the syndesmotic region are suspected, an MRI (magnetic resonance imaging) scan may be performed as a follow-up. This provides detailed images of ligaments, cartilage, and soft tissues and helps the doctor determine the optimal treatment plan.
A severe ankle fracture results in a grotesque deformity of the ankle joint. Milder forms are accompanied by swelling of only the lateral malleolus or only the medial malleolus.
An open ankle fracture is a medical emergency that requires immediate surgical treatment.
Milder ankle fractures result in swelling at the ankle © Leo / Fotolia
Types, Surgical, and Conservative Treatment
When classifying ankle fractures, doctors distinguish between open and closed fractures. The location of the fracture on the outer ankle also helps further classify the ankle fracture.
- Type A: The fibula is fractured below the joint.
- Type B: The fibula is fractured just above the ankle joint. Surgery may be necessary depending on any accompanying injuries.
- Type C: The fibula is fractured above the ankle joint. Surgery is usually necessary.
There are also several special types.
Treatment of an ankle fracture depends on the type of fracture.
Treatment usually involves surgery for fractures with significant displacement. Typically, a plate is inserted at the outer ankle through a skin incision approximately 5 to 10 cm long. In addition to the plate, 5 to 6 screws are then inserted.
In the case of a Weber C fracture, a so-called syndesmotic screw is often added. This bone screw stabilizes the joint between the tibia and fibula. The primary goal of surgical treatment is to stabilize the ankle joint anatomically and preserve long-term mobility. In addition to plate osteosynthesis, screws and plates are frequently used to fixate the ankle fork and the junction between the tibia and fibula. In certain cases, an adjustment screw is inserted to stabilize the syndesmosis and prevent subsequent instability.
If there is an additional displaced fracture of the medial malleolus, screw fixation of the medial malleolus would also be advisable. Treatment is usually performed on an inpatient basis.
When and how can weight-bearing be resumed on the ankle after surgery?
Once the soft tissues have healed and the swelling has subsided, mobilization is initiated.
In the case of a stable fracture, weight-bearing begins on the 1st or 2nd day after surgery, provided there is no pain. The patient must use forearm crutches during this time.
In the case of an unstable fracture, the patient is often only allowed to bear partial weight on the joint. Depending on bone quality, a lower-leg cast or an orthosis (removable cast) may also be applied.
For ankle fractures involving both the medial and lateral malleoli, only partial weight-bearing is generally permitted.
Postoperative Care Following Fracture Surgery
Follow-up care consists of mobilization and weight-bearing within pain-free limits. This usually involves either full weight-bearing or partial weight-bearing up to 15 kg after discharge. Following surgical treatment, the ankle is initially immobilized, usually with a cast or an orthosis. Depending on the healing process, conservative therapy with physical therapy is then initiated to restore the joint’s mobility and load-bearing capacity. Partial weight-bearing on the foot is recommended for the first 4 to 6 weeks before progressing to full weight-bearing.
A brace stabilizes the ankle joint even during weight-bearing © sunnychicka / Fotolia
The metal components are usually very noticeable beneath the relatively thin layer of skin and fatty tissue at the ankle joint. Therefore, removal of the metal is often necessary. If there are no symptoms, the metal components can also remain in the bone.
You can typically resume sports activities after three to six months. The healing time for an ankle fracture depends heavily on the type of injury and the chosen treatment. While conservative therapy is usually sufficient for stable fractures, an unstable or bimalleolar ankle fracture generally requires surgery. Once fully healed, the ankle can usually bear weight without restriction again. However, if limited mobility or osteoarthritis persists, follow-up care from an orthopedic specialist is recommended.
Medications Following Ankle Fracture Surgery
In most cases, in addition to elevating the leg and wearing a cast—and for as long as the cast is worn—thrombosis prophylaxis is administered. Pre-filled syringes are available for this purpose, which the patient can self-administer once a day.
Prognosis for healing after an ankle fracture
Depending on the severity of the fracture and any accompanying injuries, the prognosis for healing is good. If cartilage damage occurred during the initial injury, the prognosis worsens.
The more severe the fracture—that is, the more likely it is to be an open fracture or the higher up the tibia the fracture is—the poorer the prognosis.
An ankle fracture can also affect the interosseous membrane, which is the connective tissue connecting the tibia and fibula. These structures are crucial for the function of the ankle joint. To avoid long-term complications, every fracture should be evaluated and treated individually by experienced specialists in trauma medicine or orthopedics.
FAQ
1. What is an ankle fracture and how does it occur?
An ankle fracture affects the inner or outer ankle and is often caused by the foot rolling or twisting. This can cause the ankle joint to become unstable, especially if the syndesmosis—the ligamentous connection between the tibia and fibula—is injured. Depending on the severity of the injury, fractures are classified according to the Weber classification into types A, B, or C.
2. How is an ankle fracture diagnosed?
The diagnosis is initially made through a physical examination and is subsequently confirmed by an X-ray. In unclear cases or when ligament or cartilage injuries are suspected, an MRI (magnetic resonance imaging) scan may also be performed. It provides detailed information on whether ligaments, cartilage, or the syndesmosis are affected.
3. How is an ankle fracture treated?
Treatment depends on the type and severity of the fracture. For stable fractures, conservative treatment with immobilization in a cast or brace is usually sufficient. Unstable or displaced fractures are treated surgically, typically with screws and plates to stabilize the ankle. In some cases, a syndesmotic screw is also inserted to secure the connection between the tibia and fibula.
4. How long does it take to heal from an ankle fracture?
The healing time is generally four to six weeks until full weight-bearing is possible, depending on the stability of the fracture and the healing process. After surgery, physical therapy usually begins early to restore mobility. Sports activities are generally possible again after three to six months.
5. Which specialists treat an ankle fracture?
Treatment is provided by specialists in trauma medicine or orthopedics who specialize in the surgical and conservative management of ankle injuries. In complex cases—such as a bimalleolar fracture or injuries to the interosseous membrane—surgical treatment by experienced specialists is particularly important to preserve the long-term function of the ankle joint.
Share this article
