Ankle Fractures: Treatment Options

Ankle Fractures: Treatment Options

Ankle fractures or a break in the bones of the ankle joint result in significant pain and impairment. Treatment of ankle fractures varies based on different factors, which will be taken into consideration by the treating health care provider. If you have sustained an ankle fracture, it is important to seek care. Left untreated, particularly if the bones are fractured and left in an abnormal position, they may not heal correctly and may not heal at all.

In addition, complex fractures that are left untreated lead to a higher rate of arthritis in the future. Nonsurgical management of ankle fractures may be considered when a bone is broken but still in a relatively normal position. This is referred to as a nondisplaced fracture. The ankle must also be considered stable, meaning the supporting ligaments are intact. In addition, patients that are not healthy enough to undergo surgery will be treated conservatively without surgery.

Depending on the fracture type and surgeon preference, the patient may be treated with a walking boot or cast. Over time, the surgeon will allow the patient to bear weight on the injured leg as the x-ray shows bone healing and as symptoms improve. Operative management for ankle fractures is used when the bones have moved from their normal locations, called a displaced fracture, or the ankle fracture itself is considered unstable.

There are many options for fixing ankle fractures. These options depend on the bones involved, pattern of the fracture, and the surgeon's preference. For the purpose of this video, we will discuss the treatment options for a fracture to the ankle bone on the outside of the foot, the fibula. On the day of surgery, the patient will be positioned on their back. Once the patient is positioned, the surgeon has the choice of performing the repair through an open or minimally invasive incision.

An open incision will be made vertically on the outside of the ankle joint, centered over the location of the fracture. With an open incision, a metal plate is placed over the fracture and secured with screws. The minimally invasive incision involves using a small vertical incision at the bottom end of the ankle bone on the outside of the foot. This type of procedure involves using a rod, referred to as a nail construct, in the fibula bone to help stabilize the fracture.

This nail has fixation points at the top and then uses screws to secure the nail at the bottom. Sometimes, the ligaments where the shinbone and the smaller ankle bone meet, called the syndesmosis, are also damaged when the ankle bones break. If the surgeon determines these ligaments are damaged, they will perform an additional procedure to help stabilize the connection between these 2 bones and allow the ligaments to heal.

Whichever construct the surgeon chooses to use, x-rays are taken throughout the procedure to ensure the fracture is reduced and the chosen hardware is placed appropriately. Immediately after surgery, patients are typically placed into a splint or cast to protect the ankle. The progression of weightbearing to the injured leg following surgery can vary greatly, depending on the severity of the injury, surgeon preference, and surgical treatment used.

It can range from immediate weightbearing to non-weightbearing for a few months. Bone healing will be monitored via x-rays by your surgeon. If your surgeon recommends rehabilitation with a physical therapist, this will usually begin after signs of bone healing are seen on the x-ray. Whether nonsurgical or surgical treatment of an ankle fracture is chosen, the goal remains the same: to help patients recover safely and get back to their daily activities.