Ankle Fractures

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

The ankle is a ring-shaped joint formed by the lower ends of the two leg bones (the tibia and fibula) and the talus bone of the foot, held together by strong ligaments. An ankle fracture is a break of one or more of these bones, usually caused by a twist, roll or fall. The most important question is not simply whether a bone is broken, but whether the ankle is stable – that is, whether the joint remains correctly aligned under load.

Assessment

X-rays show which bones are broken and whether the joint is displaced. Fractures of the fibula are often described using the Weber system (A, B or C) according to their level, which helps indicate stability. Sometimes “stress” x-rays or a CT scan are used to judge whether the ankle is stable and whether the strong ligaments between the two leg bones (the syndesmosis) are injured. Stability is the key factor in deciding treatment.

Non-operative treatment

Stable fractures, where the joint remains well aligned, can usually be treated without surgery in a cast or a removable boot, with a period of protected weight-bearing and regular x-rays to confirm the position is maintained while it heals (typically around six weeks).

Surgical treatment

Unstable or displaced fractures – where the joint would not stay correctly aligned – are usually treated with surgery to restore the exact position of the joint surface and hold the bones with plates and screws (and, where the syndesmosis is injured, a screw or flexible device to hold the two leg bones together). Precise realignment of the ankle joint is important, because even small residual displacement is associated with poorer long-term outcomes.

What the evidence shows

For clearly unstable fractures, surgery gives more reliable alignment and better function. For some isolated, minimally displaced fibula (Weber B) fractures the evidence is more balanced – studies show good results with both careful non-operative treatment and surgery, so treatment is individualised. This is why an accurate judgement of stability is central to management.

Complications

Most ankle fractures heal well, but risks include:

●      Wound and infection problems – the skin over the ankle is thin, and wound issues are one of the more common complications after surgery, particularly in smokers and people with diabetes.

●      Malunion or a poorly reduced joint – healing out of position, which can accelerate wear.

●      Post-traumatic arthritis – any injury to the joint surface increases the long-term risk of ankle arthritis.

●      Stiffness, hardware irritation (plates and screws are close to the surface and are sometimes removed), non-union (uncommon), and blood clots.

●      Syndesmosis malreduction – if the two leg bones are not held in the correct relationship, which is why this is checked carefully during surgery.

Summary

Ankle fractures range from stable breaks that heal in a boot to unstable injuries needing surgery to restore the joint precisely. Judging stability is the key to correct treatment. Dr Spelman will assess the fracture pattern and stability and recommend the most appropriate approach for your ankle.