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Ankle Fracture

Last updated May 1, 2018

Approved by: Maulik P. Purohit MD, MPH

A Pott's fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Broken Ankle
  • Fracture of the Ankle
  • Fractured Ankle

What is Ankle Fracture? (Definition/Background Information)

  • An Ankle Fracture is a break or crack, in one or more pieces of the bones that make up the ankle joint
  • A majority of the injuries that cause Ankle Fractures occur from high-energy impact, due to athletic sports or motor vehicle accidents. Other reasons for an Ankle Fracture also include, fall from a substantial height
  • This injury predominantly occurs in older individuals and young athletes, who participate in rough or high-impact sports

Who gets Ankle Fracture? (Age and Sex Distribution)

  • Ankle Fractures may occur in individuals of all ages, gender, races, or ethnic groups
  • Young athletes, who participate in high-impact sports, or older individuals with weak bones, have the highest rate of occurrence of such fractures

What are the Risk Factors for Ankle Fracture? (Predisposing Factors)

Common risk factors associated with Ankle Fractures include:

  • Participation in high-risk contact sports, such as basketball, football
  • An advanced age (the elderly are more prone to Ankle Fractures)
  • Reduced bone mass (osteoporosis) in postmenopausal women, or inactive older individuals (having a lack of physical activities or exercise)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ankle Fracture? (Etiology)

Some of the common causes associated with an Ankle Fracture may include:

  • A direct fall on the ankle from a significant height
  • Direct trauma to the ankle, such as due to an automobile accident
  • Participation in any rough or high-impact sport

What are the Signs and Symptoms of Ankle Fracture?

Signs and symptoms of an Ankle Fracture include:

  • Severe and immediate pain at the site, where the injury occurred
  • Swelling, noticeable deformity of the ankle
  • Feeling of a tender sensation when touched
  • Noticeable bruising
  • Inability to apply any weight, put pressure on the ankle

How is Ankle Fracture Diagnosed?

Diagnostic methods that a physician may use to help diagnose an Ankle Fracture include:

  • Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, contusions within the ankle. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history may aid in arriving at a definitive diagnosis
  • X-ray: X-rays are commonly used in evaluating a fracture; to see if the bone has been displaced. This diagnostic imaging test helps provide a clear image of the bone, identify exact location of the injury, and determine the extent of the fracture
  • Computerized tomography (CT) scan: A CT scan takes a series of x-ray images from several different angles. These images are then merged, to create cross-sectional images of bones and soft tissues with the body. This allows a physician to examine the ankle and surrounding structures
  • Magnetic resonance imaging (MRI): An MRI scan is a more detailed scan that uses radio waves and a magnetic field, to generate thorough images of the interior bones and soft tissues
  • Bone scan: A bone scan is a diagnostic method used to identify any bone abnormalities, by injecting tiny amounts of radioactive material into the bloodstream

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ankle Fracture?

Complications associated with Ankle Fractures include:

  • Degenerative joint disease (osteoarthritis)
  • Osteonecrosis: A serious disorder characterized by the temporary or permanent disruption of blood flow, to the bones
  • Abnormal deformity, permanent disability of the ankle
  • Prolonged chronic pain
  • If any part of the ankle joint protrudes through the skin, bacteria may cause an infection to the exposed bone. This is called osteomyelitis
  • Permanent damage to nerves and blood vessels, around the ankle joint
  • There may be an abnormal pressure build-up within the muscles around the ankle. This may reduce the blood flow and prevent nourishment and oxygen, from reaching the nerve and muscle cells (termed as compartment syndrome)
  • Non healing of the fracture site is a serious complication

How is Ankle Fracture Treated?

A high percentage of Ankle Fractures require surgical procedures to address the condition. However, this injury may also be treated non-surgically, depending on the individual’s specific circumstance.

Nonsurgical treatment measures for Ankle Fractures are:

  • Any activity that further aggravates the ankle condition should be avoided. The physician would normally advise to refrain from all such activities, until the symptoms stop and the bone heals
  • Complete immobilization of the ankle with a cast, is required to restrict movement
  • Applying ice to the ankle, can help with pain and reduce any swelling
  • Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat an Ankle Fracture. These medications can help decrease the pain and swelling
  • Individuals are likely to need physical therapy exercises after the cast is removed. The goal of these exercises is to strengthen the ankle muscles, improve flexibility, and decrease stiffness. It may take several months for an individual to complete the physical therapy program

Surgical treatment measures include:

  • Open reduction and internal fixation (ORIF): An open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as a plate, screw, or rod) is then used to stabilize the fractured bones under the skin, until it is fully healed
  • If surgery is needed to treat the ankle fracture then the surgeon may use any of the following options depending on the individuals injury. Some of the treatment options include total ankle replacement system, extended distal extremity fixation, modular external fixation system, adjustable fixation system, headless screw design, titanium alloy break-away pin with differential thread pitch, cannulated screw system and cannulated titanium screws with triple thread. 

How can Ankle Fracture be Prevented?

To prevent an Ankle Fracture, individuals should be careful and consciously aware while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Ankle Fractures include:

  • Individuals who participate in any high-risk sports, such as football, should wear appropriate safety equipment to help prevent the possibility of an Ankle Fracture
  • Wearing appropriate footwear (such as the proper shoe size), may help prevent accidents
  • Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with appropriate calcium-intake is recommended, even after an Ankle Fracture. For women, the recommended amount of calcium, increases with age and menopause
  • Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Ankle Fracture? (Outcomes/Resolutions)

  • A high percentage of Ankle Fracture injuries, heal without any serious complications
  • A full recovery and a return to sports or normal daily activities, may usually require a few weeks to several months. This depends on the severity of the fracture
  • When properly treated and rehabilitated, usually under the guidance of a physiotherapist and a medical specialist, a high percentage of individuals regain their full strength and range of motion in the injured ankle

Additional and Relevant Useful Information for Ankle Fracture:

There is another kind of Ankle Fracture known as an Ankle Stress Fracture. Stress Fractures of the Ankle are small microfractures of the bone, associated with repetitive force and overuse of the extremity (feet), caused by activities, such as long distance running or gymnastics.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 8, 2013
Last updated: May 1, 2018