What are ankle fractures?

Ankle fractures are extremely common. A fracture and a break are the same thing, fracture is just the medical term for a broken bone. There is a huge range of fractures, from a small crack in the bone that can be walked on and needs no treatment, all the way up to a major injury where the bone is broken into many pieces, the joint is damaged or the bone has come through the skin.

How do ankle fractures happen?

Fractures can occur through simple trips and falls or during a major injury. The amount of force that has gone through the bone also goes through the other tissues around the bone like the muscles, arteries, nerves and skin. ‘High energy’ injuries, such as car crashes or falling from a height, require very different management to an injury occurring through a simple trip.

Non-surgical treatment:

Bones will generally heal if left alone, the problem comes when the bone breaks and moves, as it will heal in an altered shape and this can affect the way the foot or ankle works. Bones generally take 6 weeks to heal, this can take longer in certain bones, if the injury is ‘high energy’, if the patient has poor blood flow to the leg, if the patient is diabetic, drinks too much alcohol or if they smoke.

Your fracture will be assessed by a doctor, and a decision will be made as to whether the fracture is a ‘stable’ or ‘unstable’ type. A ‘stable’ fracture is unlikely to displace (move) over time and certain fractures can even be walked on. These fractures often don’t require surgery.

A cast or protective boot is often required to keep the bone still and straight while it heals. Some fractures can be walked on from the day of injury others need the weight to be kept off for the full 6 weeks.

Surgery

For some ankle fractures (unstable fractures) surgery may be required. Surgery is designed to place the bones back in exactly the right position and fix them there with metal screws and specially designed plates. The surgery does not immediately fix the bones but holds them in place while they heal back together, this process still takes 6 weeks or so (longer if poor blood flow, diabetes, excess alcohol or nicotine). In rare circumstances an external frame with pins holding the bones still may be the best form of treatment.

After surgery it is important the leg is kept elevated to keep the swelling down. The leg will be in a cast or protective boot for around 6 weeks. A review will be required at 2 weeks to check the wounds and remove stitches.

Fractures may take twice as long to heal or may never heal if you smoke tobacco or use nicotine products, including e-cigarettes. It is crucial you don’t smoke (including e-cigarettes) or take anti-inflammatories for at least 8 weeks after the surgery.