Ankle Fractures

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ANKLE FRACTURES (BROKEN ANKLE)

By Dr. Michael M. Cohen, DPM, FACFAS

Ankle fractures, otherwise known as broken ankles are regardless of how well the ankle was repaired. Many of these patients will inevitably require additional surgery in the future to eliminate common injuries in people of all ages and lifestyles. They may occur during any sport involving a twisting or jumping motion such as football, basketball, ballet, and running. They may also occur as a result of a motor vehicle accident, slip or fall from a height. People (particularly post-menopausal women) with osteoporosis may be susceptible. When one breaks an ankle, they have fractured one or more of three bones which make up the ankle. If treated improperly the injury could lead to long-term disability. The ankle joint is made up of the tibia (shin bone) the larger of two bones in the lower leg and flares out at its lower end forming a knob on the inside of the ankle called the medial malleolus and another flare in the back known as the posterior malleolus. The smaller of the two bones in the leg is the fibula and flares out on the outside of the ankle to form the lateral malleolus. The tibia and fibula rest on the talus, a wedge-shaped bone connecting the foot to the leg. We think of the ankle as a room with three sides and a roof. The tibia forms the roof, the medial malleolus (inside wall), and the posterior malleolus (backside wall). The lateral malleolus forms the outside wall of the room. Ligaments connect these structures together to guide movement and assure stability. If a major ligament such as the Deltoid or Syndesmotic ligament is torn the ankle is generally considered unstable. A syndesmotic tear may involve a fracture of the fibula near the knee (Maisonneuve fracture). The lateral malleolar ankle fracture is the most common, and bimalleolar (lateral and medial) the second most common. When all three sides are fractured (medial, lateral, and posterior) the injury is referred to as a trimalleolar fracture. As the number of fractures or level of impact increases so does the risk of long-term damage to the ankle joint. Ankle fractures may be nondisplaced (in correct position) or displaced (misaligned). High velocity fractures are known as Pilon fractures and have the worst long-term prognosis because of the extensive comminution and damage to the joint. These fractures inherently pose the worst long-term prognosis because the ankle shatters in many pieces and quite often lead to chronic disability and arthritis pain. The procedures may include fusion where the bones are welded together or an ankle replacement. X-rays of the ankle and knee are required to diagnose an ankle fracture. More advanced imaging such as CT or MRI is often necessary to determine the extent of the injury. With modern imaging techniques, a three-dimensional recreation of the fracture can be obtained with a CT scan allowing the surgeon to fully assess the fracture. Treatment is based on the alignment and stability of the ankle with the goal being to heal the fracture(s) as close to perfect as possible. A fracture displaced 2 or more millimeters can result in long term problems and often necessitates an operation. Unfortunately, arthritis may develop even when the ankle has been placed in good alignment because of the irreparable damage done to the bone and cartilage at the time of injury. Not all fractures require surgery. Simple nondisplaced fractures may be treated with a cast or walking boot. More severe injuries however require surgical reduction using specialized plates and screws. A foot and ankle specialist may wait one to three weeks for swelling to resolve before the ankle is surgically repaired. After surgery, patients must remain non-weight bearing for a period of anywhere from 4-6 weeks to a few months depending on the severity of the fracture. A graduated rehabilitative period is prescribed during the postoperative period to allow the patient to regain movement, strength, and balance. Risk factors for poorer outcomes in proper healing of ankle fractures include smoking, diabetes (especially if under poor control), age, and peripheral neuropathy. ▸ Michael M. Cohen, DPM, is a Board-Certified Foot and Ankle Surgeon and Diplomate of the American Board of Foot and Ankle Surgery. He is a Fellow of the American Board of Foot and Ankle Surgeons and Board Certified and Diplomat of the American Board of Podiatric Medicine. He practices with the Foot, Ankle and Leg Specialists of South Florida specializing in lower leg injuries and reconstructive surgery of the foot and ankle. The South Florida Institute of Sports Medicine in Weston is located at 1600 Town Center Blvd., Suite C, (954) 3895900 and in Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901. The practice website is www.SOUTHFLORIDASPORTSMEDICINE.org.

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