Ankle fractures are unfortunately a common injury that can lead to a lot of disability and pain when the alignment of the ankle joint is not restored anatomically. Even in cases of very well done surgery, some patients can still have some limitations and pain, however, anatomic restoration of the alignment of the bones and stabilizing the ligaments helps to minimize the risk of pain and arthritis. The bones of the ankle consist of the tibia, the fibula and the talus. When referring to an ankle fracture, surgeons are specifically referring to the fibula and tibia that are injured. Ankle fracture result typically from rotational injuries, such as a twisting motion that is combined with a fall. Higher energy injuries can occur as well, such as from motor vehicle accidents, bike accidents, or falls from height. The bones can be broken minimally in some cases such as when just the little bone is broken and there is very little ligament damage and patients are allowed to weight-bear with a boot. Alternatively, multiple bones can be broken with damage to multiple ligaments requiring a complex surgery to reconstruct the ankle.
The mechanism of the injury is important and this can help to understand the amount of energy that caused the fracture and helps to determine to what extent the soft tissue was injured. Pain is a notable finding for ankle fractures as one would expect. Understanding if the ankle had to be reduced (“popped back in place”) helps to understand the extent of the injury and if surgery is required. The skin is examined for any blister or wounds that can occur with ankle fractures and the amount of injury to the skin if present may require delaying the surgery until the skin conditions improve and this can take weeks in some cases. Xrays are required to assess the presence of a fracture and simply because someone can put pressure on their ankle, does not mean that a fracture has not occurred. Additionally imaging such a stress xray to determine the integrity of the ligaments may be ordered to determine if the ankle is stable. If there is a clear injury that needs surgery, a CT scan may be ordered to determine the extent of the bony injury so surgery may be planned appropriately.
In some cases, the fracture is minimally displaced (shifted) and the ligaments are not significantly involved.If this is the case, then the treatment can consist of weight bearing immediately with support such as a CAM boot for a 5-6 weeks with a transition to a brace and therapy. X-Rays are taken to ensure that the alignment is stable and the fracture is healing well. If there is concern about the alignment in followup or if the fracture fails to heal after many months, surgery may still be required. In cases where the alignment of the ankle is not acceptable, multiple bones are involved, or severe ligamentous injury has occurred - surgery may be offered as a superior solution to non-surgical treatment in order to restore the alignment of the ankle and minimize the risk of arthritis. In some rare cases, the overall health or needs of the patient preclude surgery and this is individually discussed and an alternative treatment plan is formulated. Historically, many surgeons focused only on the bones and did not consider reconstructing the ligaments as well. Although, there is no “perfect” method to surgically treat an ankle fracture, at Northwestern, we have researched and published on ankle fractures and patient outcomes and recognize that both restoration of the bony fractures and the ligament injuries is ideal for most patients in achieving the best functional outcomes and minimizing the risk of arthritis. We use modern techniques with anatomic plating and ligament reconstruction including the Tightrope and Internal brace to do our best to restore the anatomic alignment of the ankle and maximize your function.
Our Published Literature Related to Ankle Fractures
1. Anatomic Risk To The Neurovascular Structures With A Medially Based All-Inside Syndesmosis Suture Button Technique. Journal Of Foot & Ankle Surgery. (2020)
2. Reconstruction Of Malunited Ankle Fracture. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
3. Ankle Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
4. Arthritis Of The Ankle. Essential Orthopaedics. (2019) - Book Chapter
5. Osteotomy Of The Tibia & Fibula. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
6. Revision Total Ankle Replacement. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
7. Total Ankle Replacement. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
8. The Use Of Bulk Fresh Osteoarticular Allografts In Ankle Reconstruction. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
9. Tibiotalocalcaneal & Pantalar Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
10. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2019) - Book Chapter
11. Overview Of The Ankle & Foot. Essential Orthopaedics. (2019) - Book Chapter
12. Biomechanical Analysis Of Instability In Rotational Distal Fibula Fractures (OTA/AO 44-B1) With An Intact Deltoid Ligament. Journal Of Orthopaedic Trauma. (2019)
13. Deltoid Ligament Repair Reduces & Stabilizes The Talus In Unstable Ankle Fractures. Journal Of Orthopaedics. (2019)
14. Ankle Fractures: Open Reduction Internal Fixation. Key Techniques In Orthopedic Surgery. (2018) - Book Chapter
15. Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes Of Surgically Managed Ankle Fractures. Foot & Ankle International. (2019)
16. Outpatient Management Of Ankle Fractures. Orthopedic Clinics Of North America. (2018)
17. Leg, Ankle, & Foot Diagnosis & Decision-Making. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
18. Imaging Of The Foot & Ankle. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
19. Operative Treatment Of Posterior Malleolar Fractures. Open Orthopeadics Journal. (2017)
20. Management Of Acute Injuries Of The Tibiofibular Syndesmosis. European Journal Of Orthopaedic Surgery & Traumatology. (2017)
21. Predictors Of Patient-Reported Function & Pain Outcomes In Operative Ankle Fractures. Foot & Ankle International. (2017)
22. Chronic Syndesmotic Injuries & Reconstruction. Techniques In Foot & Ankle Surgery. (2017)
23. Anterior Approach For Ankle Arthrodesis. Journal Of Bone & Joint Surgery Essential Surgical Techniques. (2017)
24. Total Ankle Arthroplasty Versus Ankle Arthrodesis-A Comparison Of Outcomes Over The Last Decade. Journal Of Orthopaedic Surgery & Research. (2017)
25. Total Ankle Arthroplasty Versus Ankle Arthrodesis-A Comparison Of Outcomes Over The Last Decade. Journal Of Orthopaedic Surgery & Research. (2017)
26. Guest Editorial: Soft Tissue Reconstruction In The Foot & Ankle. Techniques In Foot & Ankle Surgery. (2017)
27. A Biomechanical Comparison Study Of A Modern Fibular Nail & Distal Fibular Locking Plate In AO/OTA 44C2 Ankle Fractures. Journal Of Orthopaedic Surgery & Research. (2016)
28. A Novel Algorithm For Isolated Weber B Ankle Fractures: A Retrospective Review Of 51 Nonsurgically Treated Patients. Journal Of The American Academy Of Orthopaedic Surgeons. (2016)
29. Safety & Outcomes Of Inpatient Compared With Outpatient Surgical Procedures For Ankle Fractures. Journal Of Bone & Joint Surgery. (2016)
30. Open Reduction & Internal Fixation Of Ankle Fractures. Operative Techniques In Foot & Ankle Surgery. (2016) - Book Chapter
31. Ankle Syndesmosis Injuries. Advanced Reconstruction Foot & Ankle. (2015) - Book Chapter
32. Branching Patterns Of The Superficial Peroneal Nerve: Implications For Ankle Arthroscopy & For Anterolateral Surgical Approaches To The Ankle. Journal Of Foot & Ankle Surgery. (2015)
33. General Principles. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
34. Generalized Conditions. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
35. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2015) - Book Chapter
36. Acute & Chronic Injuries To The Syndesmosis. Clinics In Sports Medicine. (2015)
37. A Comparison Of 30-Day Complications Following Plate Fixation Versus Intramedullary Nailing Of Closed Extra-Articular Tibia Fractures. Injury. (2015)
38. Arthroscopic Transfibular Approach For Removal Of Bone Fragments In Posterior Malleolar Fracture: Technical Tip. Foot & Ankle International. (2015)
39. Evaluation Of Posterior Malleolar Fractures & The Posterior Pilon Variant In Operatively Treated Ankle Fractures. Foot & Ankle International. (2014)
40. Isolated Adult Tillaux Fracture: A Report Of Two Cases. Journal Of Foot & Ankle Surgery. (2014)
41. Relationship Among Radiographic Ankle Medial Clear Space, Sex, & Height. Orthopedics. (2014)
42. Posterior Pilon Fractures: A Retrospective Case Series & Proposed Classification System. Foot & Ankle International. (2013)
43. Posterior Malleolus Fracture. Journal Of The American Academy Of Orthopaedic Surgeons. (2013)
44. Variability In Radiographic Medial Clear Space Measurement Of The Normal Weight-Bearing Ankle. Foot & Ankle International. (2013)
45. Radiographic Evaluation Of The Normal Distal Tibiofibular Syndesmosis. Foot & Ankle International. (2012)
46. Ankle Fractures. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
47. Arthritis Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
48. Introduction To Arthroscopy Of The Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
49. An Anatomical Way Of Treating Ankle Syndesmosis Injuries. Journal Of Foot & Ankle Surgery. (2011)
50. Introduction To Magnetic Resonance Imaging Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
51. Surgical Strategies: Doubled Allograft Reconstruction For Chronic Syndesmotic Injuries. Foot & Ankle International. (2010)
52. Effect Of Ankle Flexion Angle On Axial Alignment Of Total Ankle Replacement. Foot & Ankle International. (2010)
53. Malunion & Nonunion In Foot & Ankle Surgery. Foot & Ankle Specialist. (2010)
54. The Foot & Ankle. Sports Medicine & Arthroscopy Review. (2010) - Book Chapter
55. Correction Of Multiplanar Deformity Of The Foot & Ankle. Preface. Foot & Ankle Clinics. (2009)
56. Overview Of The Ankle & Foot. Essential Orthopaedics. (2009) - Book Chapter
57. Ankle Injection. Essential Orthopaedics. (2009) - Book Chapter
58. Fresh Osteochondral Total Ankle Allograft Transplantation For The Treatment Of Ankle Arthritis. Foot & Ankle International. (2008)
59. Ankle & Hindfoot Reconstruction: What Is New In Ankle Arthroplasty, Allograft, & Fusion. Current Opinion In Orthopaedics. (2004)
