Ankle fracture (Broken ankle) - internal fixation

If you would like to know about ankle fracture treatment, the following information will interest you.

If you are considering surgery for a broken ankle or have an operation planned, it is important to know all you can about it. This includes:

• why you need this operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when treating an ankle fracture / broken ankle, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making choices regarding broken ankle treatment with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Your ankle is broken. A break is also called a fracture. There is no difference in severity between a fractured bone and a broken bone. Therefore your injury may be called a fractured ankle. 

The broken bones may still be in the correct place (undisplaced) or out of place (displaced). It is also possible that the ligaments that normally hold the ankle in position are also damaged.

Your type of operation will depend on the type of fracture. This should be discussed with your orthopaedic doctors.

What is the ankle joint?

The ankle is a hinge joint comprised of three bones: the shinbone (tibia), the other bone of the lower leg (fibula) and the talus at the top of the foot. The shinbone (tibia) extends down the inside of the leg to form the inner bony bump of the ankle, called the medial malleolus. The fibula runs next to the tibia to form the outer bony bump of the ankle, called the lateral malleolus. The talus is enclosed within the ends of the tibia and fibula.

The ankle joint allows the foot to bend up and down. Usually one or both leg bones break, rather than the talus.

What has gone wrong?

One or more of the bones in the ankle joint has been broken:

• It could be only the lateral malleolus at the base of the fibula that is broken
• It could be only the medial malleolus at the base of the tibia that is broken
• It could be that both the lateral malleolus and medial malleolus are both broken
• The talus may be pulled right out the joint (dislocated). This is called a fracture-dislocation

Your treatment would depend on the type of fracture and whether the fracture was displaced or not. It will also depend on how stable the fracture is. Generally, a stable fracture is easily held in position by a plaster and an unstable fracture would need to be held in place by a plate and screws.

The aim

The aim is to fix the ankle bones in the correct place while your fracture heals. If the fracture is displaced, we aim to re-align the bones to make the joint as normal as possible. We will then hold the bones in position with plates and screws while your fracture heals.

The benefits

If a displaced fracture is in a joint, it can make the joint surfaces very rough and lead to arthritis. Reconstructing the ankle reduces the risk of arthritis developing to a minimum.

Are there any alternatives?

The decision to treat a fractured ankle with surgery depends on the type of fracture. Not every fractured ankle needs to be operated on. Some can be re-aligned by pushing and pulling (manipulation) and then held in position with a plaster only.

In some cases it is better to fix the fracture with plates and screws, if treatment with a cast only is not the best option.

What if you do nothing?  

If the bones are out of place, and you do not have an operation you may develop arthritis in the ankle within a year or two.

Who should have it done?

If your ankle is broken and you are fit enough to undergo surgery, you ought to have the fracture fixed.

Who should not have it done?

If you suffer major medical problems, these should be sorted out before you have the operation. These problems include irregular heart rhythms and breathing problems.

If your leg is very swollen, you should wait for the swelling to go down before having your operation. This may take as long as six days.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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