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What is an ankle fracture?
An ankle fracture is a break in the ankle area - one of the most common injuries to weight-bearing joints. For example, a fracture can occur when running, jumping or changing direction quickly due to an unfortunate landing. Prompt medical examination and treatment are important to avoid long-term damage.
In ankle fractures, the upper ankle joint (OSG) with fibula is affected. The fractures are classified according to the fracture height of the fibula (see Weber-Classification). The medial malleolus may also be affected, in which case experts speak of a bimalleolar ankle fracture.
How does a fracture of the ankle occur?
An ankle fracture is usually caused by a sudden, uncontrolled movement under load. Twisting the ankle outwards (supination) or inwards (pronation) can lead to a fracture. Turning the foot outwards (eversion) or inwards (inversion) also puts a lot of strain on the ankle joint. More rarely, the ankle joint is damaged by a direct impact or blow, for example in a car accident or a hard collision. Other causes and risk factors:
- Associated injuries with lower leg fractures: In some cases, the ankle fractures in conjunction with a tibia or fibula fracture.
- Limited coordination or balance disorders: People with problems with body perception (proprioception) or coordination disorders have an increased risk of injury.
- Slippery surfaces: Many ankle fractures are caused by falls on wet or slippery surfaces.
Symptoms of ankle fracture: pain, swelling, bruising
A fracture of the ankle joint usually causes severe pain immediately. The foot can no longer bear weight normally. The ankle joint is swollen - as are the foot and lower leg. Other typical signs of an ankle fracture:
- Bruising: Internal bleeding causes bruising (hematoma).
- Functional impairment: The foot can no longer be moved or loaded properly. A typical symptom is limping after an ankle fracture. If nerves are affected, sensory disturbances can also occur.
- Misalignment (e.g. twisting) or open fracture: The ankle joint may be visibly displaced or twisted - in severe cases, parts of the bone protrude through the skin (open fracture).
Diagnosis: The Weber classification for ankle fractures
In the case of a stable ankle fracture, the joint itself is stable and there is only a bone fracture. If ligaments or cartilage are damaged in addition to the bone, this is referred to as a complex fracture. The Weber classification is based on where the fibula is broken - in relation to the syndesmosis ligament. The ligament holds the tibia and fibula together. These fractures are also known as Weber fractures:
Weber A
The fracture lies below the syndesmosis, which remains uninjured. This fracture is usually stable as the ligament is not affected.
Weber B
The fracture is located at the level of the syndesmosis. This can be either intact or torn. In some cases, the interosseous membrane (a thin layer of connective tissue between the tibia and fibula) is also affected.
Weber C
The fracture is located above the syndesmosis, which is always injured. Often the interosseous membrane (fixes the tibia and fibula) is also damaged. This fracture is usually unstable and requires more complex treatment.
Complex fracture: When the Volkmann triangle has been affected
In the case of Weber B and C fracture types, a wedge-shaped part of the bone may also break off at the posterior edge of the tibia - this is known as the Volkmann triangle.
Therapy: Treatment options for ankle fractures
The aim is rapid healing and long-term stability of the ankle joint. Early treatment can prevent long-term consequences such as pain, instability or restricted movement.
Treatment begins at the scene of the accident, usually by an emergency doctor - if necessary with the foot being set in place to prevent additional soft tissue damage and nerve and vascular injuries. The leg is then immobilized in a splint until arrival at the hospital.
Why is immediate treatment of a broken ankle so important?
Even minor misalignments or instabilities can damage the joint in the long term. Without adequate treatment, this can l e a d to dysfunction or osteoarthritis, for example, and in severe cases, subsequent corrections or even joint fusion may be necessary. In principle, any stable fracture with undisplaced or only slightly displaced fracture elements can be treated conservatively. If the syndesmosis ligament is also affected - especially in Weber B and Weber C fractures - and the joint is unstable, surgery is necessary!
Treatment without surgery - protection with an orthosis
If an ankle fracture is treated without surgery, the joint must be immobilized for a period of time with special ankle or lower leg orthoses. An orthosis (splint) stabilizes the ankle joint, prevents harmful movements and allows most patients to put weight on the foot depending on how much pain they feel.
The orthosis is usually worn for several weeks. If full weight-bearing is not possible, thrombosis prophylaxis may be necessary to prevent blood clots.
Surgery for ankle fractures: how long do patients stay in hospital?
Immediate surgery is essential forserious injuries such as open fractures, vascular and nerve injuries and fractures with severe soft tissue injuries.
Surgery may also be necessary if the bones are displaced (displaced fracture) and the joint is unstable. Depending on the severity, surgery is also performed on an injury to the syndesmosis.
Patients can usually leave the hospital just a few days after the operation. In the case of more complex fractures or additional injuries, a longer stay may be necessary, especially if intensive pain therapy or physiotherapy is required.
Ankle surgery: wait and see if there is swelling and caution in older patients
If the swelling in the ankle area is too severe, surgery can only be performed once the swelling has subsided. Until then, the lower leg should be immobilized and the leg should be elevated and cooled.
Patients with an increased risk due to illness are generally not operated on, for example if they have circulatory disorders of the legs, lower leg ulcers or forefoot infections.
Learning to walk again quickly after ankle fracture: early functional follow-up treatment
The ankle joint is immobilized for as short a time as possible to prevent muscle loss. Experts prefer early functional follow-up treatment in order to return to full weight-bearing in a stabilizing orthosis as soon as possible after ankle surgery: Depending on the pain sensation, the joint can be loaded in everyday life at an early stage. In addition, targeted mobility and strengthening exercises can stabilize the joint again.
Products from medi for ankle fractures
Many injuries, dislocations or fractures can be treated with an orthosis. Ankle orthoses and lower leg foot orthoses are modern alternatives to casts. They immobilize the ankle after injuries, relieve pressure after operations and protect against harmful movements during rehabilitation.
