Ankle Fractures: Causes, Symptoms, Treatment and Prevention

Source – CDC

Ankle injuries are of the most common injuries seen. The intensity of the pain, inability to walk or fear of a fractured bone are all factors that can send you seeking emergency medical attention.


Medically Reviewed by Dr. K on 9th Dec 2021.

Ankle Fractures: Causes, Symptoms, Treatment and Prevention

Your main worry may be whether or not there is a fractured bone. Without X-rays of the ankle, distinguishing between a fracture (broken bone) and a sprain, dislocation, or tendon injury is often difficult.

  • Three bones joined together to create the ankle joint.
    • The medial, or inside, of the ankle joint is made up of the tibia, the primary bone of the lower leg.
    • The fibula is a smaller bone in the lower leg that runs parallel to the tibia and forms the lateral, or outside, of the ankle joint.
    • The malleoli (singular is malleolus) are the very ends of both the tibia and fibula. They come together to form an arch on top of the talus, one of the foot’s bones.
  • The ankle joint’s bony components (tibia, fibula, and talus) are made up of these three bones.
  • The joint architecture is coated by a fibrous membrane called the joint capsule, lined by a smoother layer called the synovium. The synovial fluid formed by the synovium is contained in the joint capsule. The synovial fluid causes the joint surfaces to flow smoothly.
  • Several ligaments, which are fibres that hold these bones in place, support the ankle joint.

Ankle Fracture Causes

When you put so much pressure on an ankle joint, it becomes injured.

  • You’ve sprained the ankle if only the ligaments give way and tear.
  • An ankle fracture occurs as a bone gives way and breaks.
  • Fractures can happen when ligaments are torn at the same time.

This can be accomplished in a variety of ways:

  • In or out rolling of the ankle
  • Side-to-side ankle twisting
  • Extending or flexing the joint
  • Applying a lot of force to the joint by landing on it, as though you were jumping from a great height.

Ankle Fracture Symptoms

Ankle injuries and fractures usually have apparent signs and symptoms.

The most popular complaint is pain.

  • Sometimes, the discomfort does not originate with the exact location of the fracture.
  • You might also have pain from associated fractures in your foot (especially on the side of the small toe) or knee.
  • It usually is ankle discomfort that prevents you from walking.

Swelling around the ankle is often expected.

  • Swelling indicates either soft tissue damage across the joint with potential bleeding or fluid inside it, most likely blood.
  • Hemarthrosis is a condition in which blood collects in a joint.

Bruising (“black and blue") around the joint may appear, though not instantly. This bruising can spread to the bottom of your foot or your toes.

Severe fractures can result in visible deformities of the bones around the ankle.

  • Your skin may be stretched over a fractured bone under it.
  • You may see actual exposed bone.

If you damage the nerves or blood vessels that support your foot, you can notice increased pain, as well as pale skin, numbness, or the struggle to move your foot or toes.

When to Seek Medical Care

When you have an ankle injury, there are a few items to look at to decide if you ought to see a doctor or head to the emergency room. The following circumstances require a visit to your doctor as soon as possible:

  • You can’t put some weight on your ankle.
  • Despite taking over-the-counter pain relievers, the pain is unbearable.
  • Pressure relief at home is ineffective.

If you can’t see a doctor and have all of the signs or effects of an ankle injury, you should head to an emergency room right away.

The following signs and symptoms necessitate urgent medical attention in an emergency room:

  • Severe ankle deformity.
  • Bones that the skin can see
  • Intolerable discomfort through the use of over-the-counter pain relievers
  • You can’t move your toes.
  • You are unable to move the ankle at all.
  • Numbness in the ankles or partial numbness
  • Cold or blue foot

Exams and Tests

When a specialist examines the ankle, the primary goal is to see whether you’ve broken a bone or whether the joint has been damaged to the point of instability. Multiple fractures, a fracture combined with a ligament injury, or a ligament injury alone are common causes of joint instability.

The doctor will inquire into the injury’s past and address the following question. Different mechanisms of injuries are linked to different fracturing patterns, so these questions are essential.

  • What is the source of the discomfort now?
  • How long has it been since your injury?
  • Do you have pain in the knee, shin, or foot as well?
  • What caused the injury?
  • Is your ankle pointing inward or outward?
  • Did you detect a pop or a crack?
  • Were you able to walk right away after the injury?
  • Are you able to walk now?
  • Have you had some recent tingling or numbness in your leg, ankle, or foot?
  • Have you ever suffered an ankle injury, sprain, or surgery before?

A medical examination may be performed by the doctor, who may scan for or look for the following:

  • Bruising, abrasions, or wounds are visible.
  • Swelling, bleeding, and tissue injury 
  • Broken bones in the knee, shin, ankle, and foot may cause pain, deformities, and grinding or movement.
  • Pain, excessive joint looseness, or a complete ligament tear
  • The presence of fluid in the joint and the stability of the joint 
  • Pulse and signs of blood vessel damage
  • Both the ankle and foot have sensation and movement.

If the doctor suspects a fractured bone, X-rays of the ankle would be requested. The doctor might even order X-rays on the knee, shin, or foot, depending on the pain.

Ankle Fracture Treatment Self-Care at Home

If you suspect a fracture, contact the doctor or head to the nearest hospital’s emergency room immediately. Before you can get to a hospital or doctor’s office, you can do the following:

  • Keep the weight off the hurt ankle to avoid additional injury.
  • To further reduce swelling and discomfort, keep the ankle elevated.
  • To reduce swelling and discomfort, apply ice packs to the wounded region. Ice should not be applied to the skin. The effects of cold packs can last up to 48 hours.

Ibuprofen (Advil, Motrin) can be a good choice for ankle injuries since it works as both a pain reliever and an anti-inflammatory. However, if you have any medical issues or are taking any other medications or nutrients, consult your doctor first.

Medical Treatment

The type of injury and the stability of your joint will decide the type of splint or brace to be utilised, as well as the length of time it may be worn.

The doctor can realign the bones before applying the splint or cast if they are not correctly aligned.

  • If the bones cannot be realigned correctly in the emergency room, an operation will be required.
  • If a bone has fractured through the skin, surgery will be needed. As a bone fractures through the skin, it is referred to as a compound fracture. This isn’t the same as a simple fracture.
  • You should not put some weight on an injured ankle before the doctor decides it’s okay.

An orthopaedic doctor or your primary care doctor can put a better-fitting cast or splint on the ankle after the swelling has subsided and you have been reexamined. Depending on the fracture type, you may be given a walking cast that allows you to carry any weight, or you may be issued a non-weight-bearing cast that requires you to walk on crutches.

Your doctor can prescribe prescription-strength pain medicine for you, depending on the severity of your pain. These can only be used when necessary. When taking these medications, you should avoid driving or operating heavy machinery.

Next Steps Follow-up

The seriousness of the injury determines the extent of follow-up treatment after an ankle fracture.

You may require immediate surgery, follow-up the next day, or a follow-up with an orthopaedic doctor in 1-2 weeks.

You may just need to see the family doctor for a follow-up:

  • If you had your ankle splinted after your first visit, you would need to get a brace put on it after your return appointment.
  • The bone heals in 4-8 weeks on average after a fracture.

Prevention

It may be impossible to prevent ankle injuries.

  • All of these happen as a result of “slip and fall" accidents. The most significant prevention is to be cautious with your actions.
  • When it comes to sports, wearing the proper footwear will help reduce your risk.

Outlook

Immobilisation and non-weight-bearing exercise help most simple fractures recover quickly.

  • Many ankle fractures require 4-8 weeks to recover correctly, and it can take up to six months to regain full use and range of motion of the joint, depending on how severe they are.
  • More severe fractures, particularly those that need surgical repair, can take longer to heal
  • Any kind of fracture increases the chances of getting arthritis in the injured joint. The more serious the injury, the more likely it is that arthritis may occur.

Synonyms and Keywords

Ankle fracture, ankle break, ankle sprain, ankle fracture

Sources

  1. https://www.webmd.com/fitness-exercise/ankle-fracture#1 
  2. Author: Stephen J Wolf, MD, Staff Physician, Department of Emergency Medicine, Denver Health Medical Center.
  3. Coauthor(s): Erik D Barton, MD, MS, Associate Director, Assistant Professor, Department of Surgery, Division of Emergency Medicine, University of Utah Health Sciences Center.
  4. Editors: Steven C Gabaeff, MD, FAAEM, Attending Physician, Emergency Medicine, Sutter Amador Hospital, Jackson, CA; Expert Consultant, Medical Board of California, Sacramento, CA; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.
  5. Ankle Fracture from eMedicineHealth

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