At a glance
Main symptoms
- Sudden, severe pain at the moment of injury
- Rapid swelling and bruising of the ankle
- Being unable to put weight on the foot
- Hospital stay
- The hospital stay is usually 1–2 days.
- Recovery time
- 6–12 weeks
- Return to work
- Desk work usually after 2–4 weeks, standing jobs after 8–12 weeks, heavy physical work after 3–4 months.
The ankle joint is formed by the lower ends of the shin bone (tibia) and the calf bone (fibula) and the talus below them. The bony bumps on the inner and outer side are called the malleoli. Ankle fractures usually happen during a twist, fall or sports injury; they can involve one to three malleoli, and the ligaments that hold the two bones together (the syndesmosis) may be injured as well.
Symptoms
Typical complaints:
- Sudden, severe pain at the moment of injury
- Rapid swelling and bruising of the ankle
- Being unable to put weight on the foot
- Marked tenderness over the bony bumps
- In severe cases, a visibly deformed ankle
Diagnostic Methods
The examination checks swelling, tenderness and the circulation of the foot. X-rays show where the fracture is and how the joint is aligned. CT may be requested for complex fractures or those involving the joint surface, and stress X-rays or MRI when a ligament injury is suspected. An examination and X-ray are needed to tell a simple sprain from a fracture.
Treatment Approach
Non-Surgical Treatments
Fractures that are not displaced and leave the joint stable are treated in a splint, cast or walking boot. Keeping the leg raised, ice and pain control are important. Follow-up X-rays check that the fracture stays in place.
Surgical Treatment
Displaced fractures, or fractures that make the joint unstable, are treated with open reduction and internal fixation: the bone fragments are put back in place and held with plates and screws. If the syndesmosis is injured, it is also fixed with a screw or a special suture-button device. The aim is to restore a smooth joint surface.
Surgical Process
Performed under spinal or general anaesthesia and takes 1–2 hours, depending on the fracture. If there is a lot of swelling, surgery may wait a few days for it to settle, to avoid wound problems. After surgery the ankle is protected in a splint or boot.
Hospital Stay
The hospital stay is usually 1–2 days.
Recovery Process
- Weeks 0–2: Leg raised, walking with crutches, wound checks
- Weeks 2–6: In a boot, gradual weight bearing depending on the fracture; ankle movement exercises
- Weeks 6–12: X-ray check of bone healing, full weight bearing, physiotherapy
- Months 3–6: Balance and strength work; mild swelling can last for months
Return to Work
Desk work usually after 2–4 weeks, standing jobs after 8–12 weeks, heavy physical work after 3–4 months.
Potential Complications
Possible problems: wound healing problems and infection, deep vein thrombosis, delayed bone healing, plates and screws that bother under the skin, and nerve irritation. Fractures involving the joint surface can lead to ankle arthritis in later years.
Frequently asked questions
Do the plates and screws need to come out?
For most patients, no. If they cause discomfort, they can be removed with a small operation once the bone has fully healed.
How can I tell a sprain from a fracture?
If you cannot put weight on the foot, or pressing on the bony bumps is clearly painful, it may be a fracture. An examination and X-ray are needed to be sure.
When can I drive?
For a right ankle fracture, usually once the boot is off and you can brake safely, most often after 6–9 weeks. With a left ankle fracture, driving an automatic car may be possible sooner.
This content is for information only and does not replace examination, diagnosis or treatment. The right treatment for you is decided after an examination.