Malleolus Fracture (Fractured Ankle)

About Malleolus and Ankle

Malleoli are expanded projections, like a bony bump, at the distal end of the fibula and the tibia, at the level of the ankle joint.

This is why a malleolus fracture is most commonly referred to as fractured ankle.

The ankle is a complex joint that forms where three bones come together: the tibia, the fibula, which are above the joint, and the talus, which is below.

So the malleolus is a specific parts of the tibia and fibula that make up the ankle.

A broken ankle is usually a broken bone of the tibia or fibula, where there is the malleolus. That is why doctors also call it malleolar fracture.

Doctors classify malleolus fractures according to the area of bone that is broken.

The bony prominence at the end of the tibia is called the medial malleolus, the one in the back part of the tibia is called posterior malleolus, while the one at the end of the fibula is called lateral malleolus.

This is why we can have four main kinds of fracture:

• medial malleolus fracture
• posterior malleolus fracture
• lateral malleolus fracture
• trimalleolar fracture

Fractured ankle causes

An ankle may break during a sudden twisting or rotating movement due a fall or to a strong impact (car accident).

A fracture can occur also applying severe force to the joint by coming straight down on it as in jumping.

Fractured ankle symptoms

A malleolus fracture can have the same symptoms of a severe ankle sprain.

This is why it is important to be evaluated by an orthopedic as soon as possible.

Symptoms for a broken ankle include:

• Immediate and severe pain (even if it is not in the exact area of the fracture)
• Swelling around the ankle
• Bruising
• Tenderness
• Inability to walk on the injured leg
• Deformity of bones around the ankle (“something is out of place”)

Fractured ankle diagnosis

The doctor will discuss your symptoms and your medical history. He or she will also ask how the injury occurred and do a careful physical examination of your lower leg, ankle and foot.

If the orthopedic suspects a broken bone, he or she will order additional test such as

• Ankle X-rays.
• Stress test X-rays
• Knee, shin or foot X-rays depending on where the pain is.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI) scan. To have a high-resolution image of bones and soft tissues, like ligaments.

Fractured ankle treatment

Treatment depends on the type of malleolus fracture and on its severity.

Non surgical treatment

If the ankle is stable, you may not require surgery.

If the bones are not aligned properly the orthopedic surgeon will realign them and then place a splint or cast.

Surgical treatment

If the ankle is unstable, any bone has broken through the skin and the malleolus fracture is compound, surgery may be needed.

During the operation, the orthopedic surgeon first repositions (reduces)  the bone fragments into their normal alignment. Then special screws and metal plates are used to hold the bones together.

Pain Management

Managing pain after an injury or surgery is always fundamental to reduce recovery time.

The doctor and nurses may prescribe drugs to reduce pain such as opioids, non-steroidal anti-inflammatory drugs and local anaesthetics.

Follow up

You will not be able to bear weight on your leg until the doctor says you can.

Most fractured ankles take from 4 to 8 weeks to completely heal. If ligaments and tendons are involved it may take even longer.

Like any other type of fracture, also a malleolus fracture can increase the risk of developing arthritis in the affected joint and this is the main reason to anatomically reduce an ankle fracture.

Rehabilitation

Rehabilitation is another very important step in the healing process.

Exercises and physical therapy are fundamental and should start as soon at the orthopedic allows you to do that.

The muscles around the ankle may take several months to get strong enough so that the patients can walk again on his own without the support of a limp.

Most of the people can return to normal activities within 3 or 4 months but sometimes it makes take even a year or two.

Driving is usually possible within 2 or 3 months after the time of the injury or surgery.

Prof. Nicola Portinaro’s experience.

Prof. Portinaro is has been treating fractured ankle for more than 30 years.

He has personally performed more than 200 surgeries both in adults and child with different techniques.