What is a broken ankle?
The ankle joint is composed of three bones. Tibia and Fibula are the 2 leg bones that join together to create the roof of the ankle joint. They are tightly articulate with a short bone below called “Talus”. Most ankle fractures that are caused by rotational force involve damage to the very tips of the ankle bones known as the “Malleoli”. Occasionally, severe impaction damage can lead to extensive damage to the entire weight-bearing surface of the ankle. In addition, it is common that an injury can separate the normal connection of the Tibia and Fibula, known as a syndesmotic injury.
Is surgery necessary for all ankle fractures?
No. Many ankle fractures stemmed from a low-energy injury with minimal or no displacement. A thorough x-rays evaluation is required to make sure more severe damage is not overlooked. Occasionally, a special x-ray with a stress test or using gravity is needed to ensure there is no abnormal displacement of the joint prior to the start of non-surgical treatment (Picture below). It is essential that patients have follow-up X-rays regularly to confirm the progression of healing and detect any unwanted fracture displacement.
What are the key elements for a successful ankle repair?
It is my experience that over 80-85% of patients benefit from a surgical repair. The goal of the surgical repair is to reverse the process of damage that occurred during the injury. It is not uncommon that a subtle ankle injury with a simple broken bone can associate with cartilage damage, ligament damage, and/or ankle syndesmotic injury. Most of the associated injuries can be detected during surgical exploration or an adjunct arthroscopic assessment.
Damaged structures should be fixed with the least invasive method that allows restoration of their anatomy and mechanical properties. Patient characteristics such as osteoporosis, severe soft tissue damage, open injury, diabetes, neuropathy, or smoking should be taken into account in surgical planning. A patient with severe soft tissue and bone damage may require a staged surgical treatment often with the use of an external fixator (See the top picture)
What is the recovery after an ankle fracture repair?
Recovery from an ankle repair varies so much depending on factors associated with patient baseline, the severity of the injury, and the method of treatment. A simple ankle fracture repair usually allows immediate full-weight-bearing in a boot. A severe injury in a patient with diabetic neuropathy may need to delay walking for up to three months. On average, patients should be able to wean off from a walking boot into a normal shoe by 6 weeks.
Should the implants be removed after the fractures have healed?
Implants are removed only if they are causing troubles to the patient such as irritation, migration, pain, temperature sensitivity, or allergic reactions. It is important that the fractures are completely healed prior to implant removal.
Can a bad ankle injury lead to arthritis?
Yes. Actually, ankle injury is by far the leading cause of arthritis. The progression to ankle arthritis may take months to over 20 years depending on the severity of the damage. A collaboration between the patient and the operating surgeon is paramount to minimize the chance of arthritis. Current medical technologies offer multiple successful options both non-surgically and surgically for patients suffering from ankle arthritis.
Author: Phinit Phisitkul, MD