Ankle Fractures

Ankle fractures are among the most common types of fractures, particularly in the lower extremities. Ankle fractures can occur in a variety of different manners, but most often occur when people twist or roll their ankles while tripping or falling.

At Seaview Orthopaedics, we treat several broken ankles each month. Our foot and ankle specialists, Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury are here to help in the event of an ankle fracture.

Symptoms of an Ankle Fracture

There are several symptoms that can indicate a broken ankle. However, a severe ankle sprain can produce symptoms similar to a fracture, so it is important to be evaluated by a qualified medical professional to get an accurate diagnosis.

The most common symptoms of an ankle fracture are severe pain, swelling, and bruising of the ankle. The ankle may be tender to the touch, and you may be unable to put weight on it. There may also be noticeable deformity of the ankle, especially in cases where the ankle joint is dislocated.

Doctor Examination

During your appointment, your foot and ankle specialist will ask you questions about your medical history, symptoms, how the injury occurred, medications you are taking, and conduct a physical examination of your ankle, foot, and lower leg.

Imaging Tests

If a broken ankle is suspected, our foot and ankle specialists will order imaging tests like x-rays to determine the extent of the fracture.

X-rays. This diagnostic imaging shows if the bone is broken, how many pieces of broken bone there are, and whether there is a gap between the broken bones (displacement). The x-ray may be taken of the leg, ankle, and foot to determine the extent of your injury.

Stress test. This x-ray is done to see if your injury is extensive enough to require surgery. Your foot and ankle specialist puts pressure on the ankle and takes a special x-ray called a stress test.

Computed Tomography (CT) Scan. This scan creates a cross-sectional image of the ankle to see the full extent of the injury, showing if the fracture extends into the ankle joint.

Magnetic Resonance Imaging (MRI) Scan. An MRI provides high-resolution images of both bones and soft tissues and would indicate if ankle ligaments were affected in the injury.

Types of Ankle Fractures and Treatment

The ankle is made up of three bones: the tibia (shinbone), the fibula (smaller bone in the lower leg), and the talus, a small bone that rests between the calcaneus (heel), the tibia, and the fibula. Treatment of an ankle sprain depends on the location of the fracture, and whether other parts of the foot, ankle, and lower leg are involved.

Fibula Fractures

The fibula is the most commonly-fractured ankle bone. If the fracture only involves the fibula, it can often be treated with casting if the ankle joint is not displaced. During this time, the patient will need to avoid putting weight on the ankle while the bone heals. This can take up to 6 weeks.

If the ankle bones are displaced from the fibula fracture, the fracture will need to be surgically corrected. At Seaview, our foot and ankle surgeons typically use fixation devices like plates and screws to hold the bones in place so that they heal properly. The latest fixation methods are minimally invasive, a procedure which Dr. Green currently offers. Our foot and ankle specialists are also researching intramedullary nailing for fibula fractures, a device that can allow for immediate weight-bearing on the ankle after surgery because it is a load-sharing device. This technique will allow our patients to mobilize the ankle and return to activities and sports very quickly as compared to more traditional fixation techniques.

Tibial Fractures

Tibial fractures typically occur in the inner part of the tibia (medial malleolus) or at the back of the tibia (posterior malleolus). Tibial fractures, especially fractures of the medial malleolus, often need to be fixed with hardware. In some cases, fractures of the posterior malleolus do not need to be addressed. However, if the bones are significantly displaced, surgical fixation may be necessary. Fixation may be achieved with screws, plates and screws, or tension wiring, depending upon the nature of the fracture.

Pilon Fractures

Pilon fractures are a type of ankle fracture that occurs at the bottom of the tibia. Pilon fractures are often caused by high-energy events like a fall from height or an automobile accident. This type of fracture involves the load-bearing surface of the ankle, and can, therefore, be lifestyle-altering. Patients with pilon fractures also have a higher chance of developing post-traumatic arthritis in the ankle due to cartilage damage at the time of the injury.

Due to the impact on the bone, pilon fractures can cause the bone to break into multiple pieces. This requires surgical fixation; however, our foot and ankle surgeons may need to take a staged approach to provide the best possible results. In a staged approach, an external fixator is placed first to hold the bones in place while allowing swelling to subside. When swelling has subsided, a second procedure is performed to remove the external fixator and place internal fixation devices. In some cases, a third procedure may be performed 6 months to 1 year after the fracture to remove the hardware. This may be recommended because the ankle does not have much soft tissue coverage, and fixation hardware can become uncomfortable and disabling.

Metatarsal Fractures

Other common fractures at the level of the foot and ankle include metatarsal fractures.  Metatarsals 2, 3 and 4 are frequently treated nonoperatively; however, border digits, specifically metatarsals 1 and 5 frequently need an open reduction internal fixation because they impart a significant amount of stability to the level of the foot.

Calcaneal Fractures

Calcaneal fractures are also significant injuries that impart a significant amount of disability and morbidity to the patient. Again, calcaneal fractures are lifestyle-altering and limb-threatening injuries as well. Frequently, because of the complex nature of these fractures, the patient will require a CT scan prior to operative intervention to better elucidate fracture fragments and again, treatment will need to be done with surgical intervention. Traditionally, surgery for calcaneal fractures involves making a large J- shaped incision along the outside of the heel to fix the heel bone fracture; however, this approach has a significant amount of morbidity associated with it and a significant amount of wound healing and infectious complications. At Seaview, we now offer a minimally invasive approach using specially designed hardware, done arthroscopically with percutaneous placement of hardware to treat these fractures. Compared to traditional methods, this approach has significantly lower wound and infectious complications, allowing patients to return to activities faster. Unlike ankle fractures and metatarsal fractures which would generally heal in about 6 weeks, pilon fractures and calcaneal fractures require approximately 3 months until they heal and full weight-bearing is allowed.

Ankle Fracture Treatment in Central New Jersey and the Jersey Shore

Our board-certified foot and ankle surgeons, Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury are here to help in the event of an ankle fracture. If you would like to schedule an appointment with Dr. Green, Dr. Beights, or Dr. Fahoury at one of our office locations, please call (732) 660-6200. We look forward to helping you!