With these kinds of ankle fractures, surgery is almost always required as a form of treatment. In this article, we are going to cover a few examples of high-impact ankle fractures, what to expect from them, and the treatment you would need to heal properly.
A medial malleolus fracture is a break on the inside “bony knob” portion of your ankle (lower tibia). While this fracture can be caused by non-impact injuries, it is rare. In most cases, a high-impact must hit the inner ankle to cause it to break. One of the downsides with this type of break is that the ankle can become impacted or indented in addition to the break, driving the medial malleolus into the rest of the ankle joint. When this happens, bone grafting is often used to give the new bone a structure to grow on.
The symptoms of a medial malleolus fracture include immediate to severe pain, swelling around the ankle, tenderness to touch, inability to bear weight on the foot, visible displacement or deformity of the ankle, and bruising.
A medial malleolus fracture is diagnosed through a physical examination, which is followed up by manipulation of the ankle. You may be given x-rays, although the symptoms are often pretty clear cut when it comes to this type of fracture.
When it comes to treatment, the majority of medial malleolus fractures require surgery as the lining of the bone (periosteum) will often fold into the fracture site at the time of the injury. This will occur if there is 2 millimeters or more of separation between the fracture fragments. Surgeons will use internal fixation to apply screws, rods, plates, and wires to hold the bones in place.
An avulsion fracture occurs when a portion or fragment of the bone is pulled away at the attachment point of a ligament or tendon. This type of fracture can be caused by repetitive long-term movement (traumatic traction) or from single high-impact traction of the ligament or tendon. This can occur anywhere in the body where a tendon can bear more load than the bone, but it commonly occurs in the ankle at either the medial malleolus, the fifth metatarsal, or at the talus or calcaneus (heel) bones.
The symptoms of an avulsion fracture in the ankle include immediate swelling post-injury, the development of bruising, the inability to bear weight on the ankle, and immediate pain. It may present similarly to an ankle sprain, with significant swelling and localized tenderness.
An avulsion fracture is diagnosed through an x-ray, MRI, or CT scan. When there is an ankle sprain, it is always recommended to look at the fifth metatarsal to ensure that there isn’t an avulsion fracture, as this often gets overlooked.
If the fifth metatarsal is not displaced, you will be given a walking boot or cast that is to be worn for 4-6 weeks. If surgery is required, the bone is removed or fixed with osteosynthesis material. You will be required to use crutches to avoid putting any weight on the foot until it is fully healed.
A pilon fracture is when you break your shinbone (tibia) down near the ankle. For a pilon fracture to occur, you need a high-energy impact situation such as a fall from extreme heights, a motor vehicle accident, or a skiing accident. The force of the impact will drive the talus bone (lower portion of the ankle joint) into the tibia, breaking both it and often the fibula as well. Individuals with pilon fractures often present with other injuries too due to the excessive force of the impact.
The symptoms of a pilon fracture include swelling and bruising of the leg and ankle. Severe pain of the leg and ankle, inability to put weight on the foot, or a deformed or crooked-looking ankle.
A pilon fracture is diagnosed through a full physical exam. This includes inspecting the leg and ankle for swelling, bruising, and pain that presents at touchpoint. The blood supply to your ankle and leg will be checked, and x-rays may be given to determine the extent of the fracture. You may also need a CT scan.
If you are lucky enough for your tibia bones to align correctly, you won’t need surgery and instead will get splints, casts, pain medicines, or a boot as part of your healing treatment. However, if the pilon fracture presents as unstable (not in alignment), you will need to immobilize the ankle until your surgeon can do an internal fixation. Internal fixation is where the surgeon places your bones in the correct position and then uses special plates and screws to keep them in place as you heal.
You may need multiple surgeries to fix a pilon fracture, and you will need to do physical therapy to build up the range of motion and strength. A removable brace/splint and crutches are often provided in the several months after the injury.
While not the last of potential high-impact breaks, another common one is the trimalleolar fracture, which is where you fracture the medial, lateral, and posterior malleoli. This type of fracture often occurs during high-contact sports, in car accidents, or as a result of a fall. In addition to fracturing these bones, you can also have dislocation and ligament damage. The symptoms of this type of fracture include severe pain, tenderness, inability to walk, bruising, ankle deformity, and severe swelling. The treatment for this is surgery as it is classified as an unstable fracture