Why does it occur?
Ankle fractures typically occur from a fall (often associated with rolling the ankle), or direct trauma to the ankle. In all of these instances, a significant amount of force and stress is placed on the ligaments and bones of the ankle, leading to fractures and sometimes ligament disruption.
Typical symptoms for an ankle fracture are pain, swelling, and bruising of the ankle area. Patients often have pain when weight-bearing.
An x-ray is the gold standard diagnostic test in assessing ankle fractures. A CT scan may be ordered to evaluate more severe fractures, specifically those that appear to involve the joint. An MRI may also be ordered for further evaluation of subtle fractures or to further evaluate the ligaments and tendons of the ankle.
There are many types of ankle fractures. Some fractures involve a small piece of bone being torn off (avulsion fracture), while others fractures are more serious and jeopardize stability of the ankle. Treatment of ankle fractures depends on a multitude of factors including fracture location, number of fracture fragments, fracture displacement, date of injury, bone blood supply, age, functional status, ligament involvement, and ankle joint stability.
Most non or minimally displaced fractures as well as avulsion fractures (i.e. a fracture where one of the ankle ligaments tears off a small piece of bone) can be treated without surgery. In these cases, the patient will normally be placed into a cam boot (large boot that looks like a ski boot), short-leg cast (cast that goes up to the mid-calf), or even an Aircast depending on the type of fracture. Whether or not you can weight-bear depends on the particular fracture. Those fractures which are non-weight bearing will require you to use either crutches or a knee scooter. Nonoperative fractures typically take up to 6 weeks to heal. Once healing is confirmed, patients are normally transitioned into an aircast or ankle brace. Physical therapy is usually started at this time and lasts for approximately 6 weeks. Most patients return to normal activity in 3-4 months.
Surgery is usually recommended for fractures that are displaced or in cases where the ankle joint is unstable. Surgery is designed to realign the fracture to its correct anatomic position and stabilize the ankle joint. The bone itself is usually repaired via a number of different types of hardware including plates and screws, and rods, as well as Internal Bracing techniques.
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Patients who undergo surgery will be placed into a splint immediately after surgery and then transitioned into a short-leg cast (cast goes to the level of the mid-calf) one week after surgery. Patients usually remain in the cast for an additional 3 weeks, after which they are transitioned into a cam boot. Some patients whose fracture is relatively stable can go into a Cam Boot right away. Patient’s will remain non-weight bearing for up to 4-6 weeks. Physical therapy along with gradually increased weight-bearing is usually started around 6 weeks. Physical Therapy can last anywhere from 6-12 weeks and return to normal activity normally takes a minimum of 3 months. Please keep in mind that the recovery process varies depending on the fracture type, surgery performed, patient’s adherence to instructions, and patient’s individual rate of healing.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.