Ankle fractures can happen to anyone, and when they occur, you will need immediate care. These fractures typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle, like during a slip or fall. The instinct is to rush to the emergency room, where a pricey and usually very long visit awaits you. At Foot and Ankle Associates of North Texas (FAANT), we have you covered and, in most cases, can get you in on the same day during our normal business hours.
Anatomy of the Ankle
The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down. The three bones are the tibia and fibula in the leg, and the talus in the foot. During an ankle injury, the ligaments that stabilize this joint are designed to prevent dislocation of the joint. Unfortunately, during the rapid motion that occurs during high velocity injuries, these ligaments can fail or in more severe cases, the bones themselves can fracture.
Types of Ankle Fractures:
- Avulsion - In an avulsion injury, the attachment of the ligament pulls a small chip of bone away. In these more minor injuries, treatment includes immobilization in a boot or cast. Immobilization may be required anywhere from 4-8 weeks in a healthy patient.
Avulsion fracture of the fibula - seen at the tip of bone on the right
- Nondisplaced Fracture - In a nondisplaced fracture, the bone fracture fragments are in good position and should heal without surgery. Casting in a below the knee cast will be needed for 6-8 weeks, followed by walking in a walking boot for several more weeks, along with physical therapy to regain strength. Return to physical activities usually takes 3-4 months.
Nondisplaced fracture of the fibula - see on the right
- Displaced Fracture - In more severe injuries where fracture fragments are displaced or multiple fractures have occurred, surgical repair is required. If surgery is not performed, bones will not heal in the appropriate alignment, or they may not heal at all, and chronic arthritis and pain will develop. If a more severe injury has occurred immediate surgical repair may be required, especially if there is exposed bone. Typically, ankle fractures do not present to the office or Emergency Room immediately. Delayed presentation of fracture allows excessive swelling to occur, making surgical closure of skin difficult. Generally, if swelling is noted, your surgeon may wait several days to weeks until swelling has subsided before attempting correction.
Displaced fibular fracture - seen on the right
Surgery for Ankle Fractures
Patients will have general anesthesia for this procedure and a nerve block for pain control after they are asleep. Depending on the complexity of the fracture, surgery usually takes about 45 minutes to 2 hours. Surgery will include the use of plates and screws to fixate the fracture or possibly external fixation with wires and rings in more complex fractures.
Patients are typically able to go home about an hour after surgery, in a non weight bearing cast or splint. Patients will then ice, elevate, use crutches and take pain medication as prescribed by their surgeon. Pain typically is rated 3 out of 10 while at rest if all post-operative instruction are followed, and pain often reduces in several days enough where oral medication can be used and you are sent home.
A below the knee cast or splint, stays in place for about 2-4 weeks, sometimes up to 6-8 weeks in a cast if severe injury has occurred, or delayed healing is noted on x-rays, but most patient experience the former. Patients will transition into a walking boot after the cast is removed and begin physical therapy until about weeks 8 after surgery, at which time slow return to normalcy begins. Normal physical activities can typically be resumed in about 3 months after surgery.
If you have suffered an ankle injury, contact FAANT to be seen by a physician as soon as possible! A visit to the ER will result in a costly bill, and a referral to see us after for follow-up care, so cut out the middle man and get started on the road to recovery! Delaying treatment will only lead to prolonged pain and poorer outcomes.