Ankle fractures often occur after twisting injuries.  A slip on the ice is a common story leading to an ankle fracture.  Ankle fractures can also occur traumatic events such as falls or motor vehicle accidents. The fracture or ‘break’ typically involves the Fibula and/or the Tibia (bones of the ankle joint) and are often associated with damage to the ligaments stabilizing the bones.

Ankle fractures typically occur in characteristic patterns depending on the position of the foot/mechanism of injury. Some fractures can occur without disruption of the ankle joint/displacement of the bones (non-displaced fractures), while other injuries lead to gross shifting of the fracture fragments/alignment of the joint. At times the injury is significant enough to cause the joint to dislocate.

Some ankle fractures can be treated without surgery if the bony fragments are in overall good alignment. These patients can be managed in a cast or possibly a removable boot or Cam walker. There are other patients that have a fracture with a small amount of displacement or shift of the bones.  Special x-ray tests will typically be done to determine the stability of the injury. If the injury is stable (minimal shift of the bones) then a non-operative treatment course is recommended.

Displaced ankle fractures and ankle fractures in which the joint has dislocated typically require surgery. The surgery for an ankle is termed an ankle ORIF (open reduction internal fixation).  The goal of ankle fracture surgery is to return the bones of the ankle to their anatomic or pre-fracture position and then the bone fragments are held in position with plates screws or other metal implants. At times the ligaments damaged during the injury are repaired or stabilized/reinforced.  This surgery typically takes 2-3 hours in the operating room. Most patients are allowed to go home after surgery. Nerve blocks are typically performed that allows good pain relief following surgery.

Recovery from ankle ORIF includes initial immobilization in a splint (placed in the operating room).  Most patients are placed into a cast at their post-operative appointment. Patients are kept non-weight bearing for at least 6 weeks s/p surgery.  Crutches or a knee walker are required. Once the fracture has healed adequately (usually at 6 weeks s/p surgery) the patient may start weight bearing in a removable boot. Physical therapy is started when the cast is removed.