What is an ankle fracture?
The ankle is the articulation between the leg and the foot. It consists of the tibia, fibula, and talus, which form a mortise joint. Fractures of the ankle most commonly involve the bony knuckles around the joint, namely the lateral, medial, and/or posterior malleolus. This can be associated with an injury to the syndesmosis, the ligament complex that stabilises the tibia and fibula above the ankle joint. An injury that predominantly involves the articular surface of the tibia is known as a tibial plafond or pilon fracture. A tibial plafond fracture usually results from a high-energy mechanism and is associated with significant soft tissue injury.
What are the symptoms of an ankle fracture?
Ankle malleolar fractures often occur from a rotational force through the foot. Patients with an ankle fracture normally present with acute pain and swelling around their ankle following a traumatic event. In addition, patients usually report pain in their ankle on weight-bearing and with movement.
What are the management options for an ankle fracture?
The management of an ankle fracture depends on multiple factors, including the type of fracture, its displacement and associated injuries. As a general rule, an ankle fracture is considered unstable if more than one malleolus is affected or if there is an associated syndesmosis injury. Non-operative treatment for an undisplaced and stable ankle fracture normally warrants immobilisation and offloading of the injured limb in a below-knee backslab/cast and/or a controlled ankle motion (CAM) boot. Surgical fixation is indicated for displaced or unstable ankle fractures to reduce the risk of post-traumatic arthritis. Internal fixation methods typically involve the use of a plate and screws, and/or a suture button implant for stabilisation of the syndesmosis.
What is the recovery after surgical fixation of my ankle fracture?
After your ankle fracture has been reduced and internally fixed, you will likely require a period of weight-bearing restriction through your injured ankle and offloading in a CAM boot for up to 12 weeks. You will need to wear your CAM boot when ambulating only, and will be instructed to do early ankle and foot range of motion and stretching exercises to reduce your stiffness. Once your surgical dressings have been removed after 2 weeks and your wounds are healed, you will also be encouraged to desensitise your surgical scars by massaging your wounds with a moisturising cream/oil, and to start exercising in the swimming pool or doing hydrotherapy. For most patients, it will take 2-3 weeks for your wounds to heal, 5-6 months for your fracture to unite, 6-7 months before you are reasonably comfortable walking in normal supportive shoes, and at least 12 months for the swelling in your ankle to subside and for full recovery to your new baseline level.