1. Ankle fractures are common.
Ankle fractures are the second-most common fracture after distal radius fractures. The incidence is between 0.1 to 0.2 percent of the population per year. Approximately one-quarter of these occur in the elderly. This rate is increasing as elderly people are staying more active. Ankle injuries constitute about 10 percent of orthopedic office visits. These can occur when the ankle twists or rolls underneath you. During sporting events, especially soccer and football, the foot is often placed in awkward positions and may be pinned by other players. If the body continues to twist around a fixed foot, the ankle can fracture. The exact pattern of fracture depends on the position of the foot as the ankle is twisting.
2. Lateral malleolus fractures are more common.
The malleoli are the two bumps you can feel on the side of your ankle. The medial malleolus is the bump closer to the other ankle. The lateral malleolus is the one away from the other ankle. The lateral malleolus is more commonly fractured. When both malleoli are fractured, this is known as a bimalleolar fracture. Bimalleolar fractures usually require surgery because they are unstable. There are also trimalleolar fractures. The third malleolus is the posterior malleolus, which forms the back of the weight-bearing surface of the ankle. Some smaller posterior malleolus fractures don't need to be fixed surgically, but the ones that affect the stability of the joint need to be stabilized with screws or plates.
3. Some ankle fractures can be treated like ankle sprains.
The anterior talofibular ligament (ATFL) is the ligament injured in a typical ankle sprain. This connects the lateral malleolus to the talus. Sometimes, the ligament doesn't actually tear, but pulls a chip of bone off the lateral malleolus instead. When this occurs, it can usually be treated with R.I.C.E. (rest, ice, compression, elevation). Sometimes, a walking boot or cast may be needed for the more severe avulsion (detaching) fractures.
4. Some fractures can been treated without surgery.
The stability of the ankle is dependent on the medial structures: the medial mallelous and deltoid ligament. The deltoid ligament connects the medial malleolus to the talus bone underneath. Fractures that don't disrupt the medial structures are most likely stable and can be treated with a walking boot or cast. These take approximately 6 weeks to heal. If the ankle fracture is a stable pattern, it may be possible to put weight on the ankle while it is healing. However, even stable fractures can be too painful to walk on, and crutches may be needed during the first few weeks.
5. Some fractures will need surgery.
If the fracture involves the medial ankle, the ankle joint itself may become unstable. If this is the case, surgery to realign the bones and hold the ankle in place is preferred.
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