Fractured or broken ankles are a common cause of A&E attendance in the UK.
Due to the number of bones, joints and ligaments in the area injuries are often complex in nature. Whilst there are many potential treatments for an ankle fracture it must first be correctly diagnosed and classified so that the best option utilised.
Proper assessment is best conducted by an orthopaedic specialist who can swiftly and correctly identify which of the bones, ligaments and areas of soft tissue have been affected.
What to do if you think you have a broken ankle
If you have a painful bruised or swollen ankle that is painful to put weight on there is a chance that you have suffered a fracture and need to attend an urgent treatment centre. You will need to call 999 if:
- You have an open wound
- Can see bone sticking through the skin, or
- Your toes have begun to lose their colour or feel numb
On your way to your appointment or A&E try to raise your ankle above the level of your heart and gently place a bag of ice or frozen peas onto the affected area. Do not take any ibuprofen before you see a medical specialist, you are however able to take paracetamol to help take the edge off the pain.
Finally, as soon as you think you may have a broken ankle do not eat or drink anything. This is because you cannot undergo surgery for a few hours after eating due to safety concerns. Avoiding food could mean access to surgery before any significant swelling sets in and a better long term outcome.
Ankle fracture treatment options
Ankle fractures are typically classified as uni (one), bi (two) or tri (three) malleolar. The mallelous are the bony prominences on both sides of the ankle. In our clinics we most commonly see either the fracture of the malleolus on the outside of the ankle or bimalleolar fracture of both bones of the lower leg, namely the tibia and fibula.
If your injury is severe enough that two or more parts of the malleoli are fractured then it is not possible to stabilise the joint simply through splinting. Instead to ensure the survival of the joint and its future health an operation is required.
Nonsurgical ankle management
If you’re fortunate enough to have only suffered a minor fracture and the bones have remained in alignment then conservative, nonsurgical treatment is the most likely option.
If there has been some minor displacement due to the fracture this can often be fixed in the clinic using a procedure called closed reduction. This requires manipulation by a doctor although the skin is not broken and it is therefore considered nonsurgical.
Treatment options include fixing the fracture to a splint or completely covering it in a cast. The least restrictive option that still provides sufficient stability and protection is often the number one choice. To remove undue pressure from the joint while it heals you will be offered crutches so that the injury remains non-weight-bearing.
After 6 to 8 weeks the bindings or casts can usually be removed to place weight fully through the joint once again.
Surgical ankle management
Multiple fractures, an unstable joint or simply a bone that has broken the skin will require you to have surgery in order to sufficiently treat the injury. This is known as an ‘open reduction’ as opposed to a ‘closed reduction’ when the skin remains intact.
Although treatment for most conditions is best delivered sooner rather than later, in the case of ankle fractures orthopaedic surgeons prefer to delay surgery until excess swelling surrounding the joint has significantly reduced. This allows for proper reconstruction of the joint and has been shown to promote better wound healing over time.