If you have injured your ankle—particularly if it feels like a simple sprain—it is tempting to try to carry on walking on it. Which can mean you don’t get an X-ray for days or even weeks. Untreated, there is a high risk of developing infection, arthritis, or even foot deformities that may impair walking. If you do have an ankle fracture, and it leads to instability and ongoing mobility issues, you are likely to require surgery. Which is why getting the correct diagnosis is vital. At Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado, you’ll get help from orthopedic specialists who have dealt with every type of ankle fracture and excel at getting you back on your feet.

OVERVIEW

An ankle fracture is also known as a broken ankle. This means one or more bones that make up the ankle joint are broken. Ankle injuries are among the most common of the bone and joint injuries. The incidence of ankle fractures is estimated to be more than five million in the U.S. per year. Women are far more likely to have a fracture than men; in fact, one in two women over the age of 50 will have a fracture in their lifetime. This is because women’s bones, even at their best (age 25–30), are generally smaller and less dense than men’s bones. Not all ankle fractures are the same. The seriousness of an ankle fracture varies. Fractures can range from small hairline fractures to complex breaks involving several bones, some of which may pierce the skin.

ABOUT THE ANKLE JOINT

The ankle joint is not simply a single joint, but two joints. The portion that is usually meant when referring to the ankle is called the true ankle joint. It is the coming together of three bones: the fibula of the shin on the outside of the ankle, the tibia, also of the shin, on the inside of the ankle, and the talus bone underneath them. It is responsible for the up and down movement of the foot. The subtalar joint is the second part of the ankle. It is the coming together of the talus above and the calcaneus (heel bone) below. This joint allows the ankle to move from side to side. These joints, along with the ligaments that hold the bones together, absorb all the stress the ankle receives when walking, running, or jumping. They carry the weight of the body and help keep one balanced on uneven ground.

MOST COMMON TYPES OF ANKLE FRACTURES

• Fibula Only Fracture (lateral malleolus fracture): This is the most common type of ankle fracture. The base of the fibula (the lateral malleolus) forms the bony lump on the outside of the ankle. It can get broken if the ankle gets twisted forcefully, it is landed on badly, or there is an impact on the outer leg.
• Bimalleolar Ankle Fracture: The second most common type of ankle fracture is a break of both the fibula on the outside of the ankle and the base of the tibia (shin bone), on the inside of the ankle. Most bimalleolar ankle fractures are serious injuries, sometimes breaking the skin. These unstable fractures can also lead to serious ligament damage requiring surgery.
• Trimalleolar Fracture: These are the most severe of ankle fractures and have a poor prognosis. With these fractures, the back of the tibia is also broken off.
• Tibia Only Fracture (pilon fracture): The tibia is the second longest bone in the body, playing an important role in standing, moving, and keeping balance. The tibia can break in one place or shatter in several places at the ankle joint.
• Maisonneuve Fracture: This type of ankle fracture can be misdiagnosed as an ankle sprain (stretched ligaments) because an x-ray of the ankle shows no break in the bone.

CAUSES

Many things can cause an ankle fracture. The most common are:

• Car accidents. The crushing injuries common in car accidents may cause breaks that require surgical repair.
• Falls. Tripping and falling can break bones in the ankles, as can landing on ones feet after jumping down from just a slight height.
• Missteps. Sometimes just putting a foot down wrong can result in a twisting injury that can cause a broken bone.

One may be at a higher risk of a broken ankle if:

• Participating in high-impact sports, including basketball, gymnastics, tennis, and soccer
• Suddenly increasing activity level, whether a trained athlete or someone who’s just started exercising
• Keeping one’s home cluttered or poorly lit

SYMPTOMS

• Signs and symptoms of ankle fractures tend to be obvious:
• Immediate, throbbing pain
• Swelling
• Bruising
• Tenderness
• Difficulty or pain with walking or bearing weight
• In severe ankle fractures, one may see obvious deformity of bones around the ankle; skin may be stretched over an underlying broken bone or is exposed

NON-SURGICAL TREATMENTS

• Stay off the injured ankle so as not to 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
• Ibuprofen (Advil, Motrin) may be ideal for ankle fractures because it acts as both a pain medicine and a medicine to keep inflammation down.
• After an ankle fracture, patients typically use crutches, walkers, or a wheelchair to keep weight off the affected limb
• A splint can be used to stabilize the ankle and help control swelling. Once the initial swelling resolves, the patient can use a walking boot or cast.

WHEN IS SURGERY INDICATED?

Up to 25% of all ankle fractures require surgical care. A decision to operate is usually based on fracture stability and the patient’s fitness for surgery. A displaced ankle fracture is where the broken bone fragments are separated. There may be breaks in one, two, or three areas, and the ankle joint may also be dislocated. Most ankle fractures with dislocations require surgical treatment. When ankles are deformed, unstable, or cause constant pain, surgery may be the only answer. Surgical treatment may involve repositioning bones using surgical pins, removing bone fragments, and repairing damaged ligaments. Often, this can be done using keyhole or arthroscopic surgery – a more precise method of surgery with shorter recovery times.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

The first thing to determine is whether you have an ankle fracture or an ankle sprain. An ankle sprain refers to damage to the ligament between bones, and an ankle fracture is an actual break in the bone. But initially, it can be very difficult to determine which injury you’ve experienced. Importantly, ankle sprains and ankle fractures are not mutually exclusive. So it’s possible to experience both at the same time. Sprain/fracture combinations are quite common, which is why you need to seek the best medical advice to ensure you receive a correct and complete diagnosis. At Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, they have a team of highly trained foot and ankle specialists experienced in assessing and treating even the most complex ankle fractures. Are you experiencing ankle pain and think you might have a fracture? Schedule an appointment today.