Ankle Fracture: Diagnosis and Treatment

Ankle fracture involves the bones forming the ankle joint. It is usually caused by road traffic accidents, industrial accidents and household injuries. Twisting your ankle can also result in a fracture.

Before reading further it would first be good to know the relevant ankle anatomy. (skip this it you have already read the page)

This fracture is of the following common types

  • medial malleoli fracture
  • lateral malleoli fracture
  • posterior malleoli fracture
  • anterior malleoli fracture

Two or more malleoli may also be fractured together.

Fracture of three malleoli is usually associated with a dislocation of the ankle joint.

fracture of ankle malleoli fracture of ankle malleoli


Symptoms of ankle fracture include

  • history of injury
  • pain and swelling over the ankle
  • movements of the ankle are painful
  • inability to walk or stand with both feet equally on the ground
  • obvious deformity over the ankle or the bones are looking as if they are out of place

On reaching the hospital

  • you will be gently examined by a doctor
  • asked to narrated how you got injured
  • any wound you have will be dressed gently
  • a pain killer injection will be given
  • a splint will be applied to your leg and foot
  • x ray of your ankle joint will be taken in two planes
  • your doctor may request a CT scan to get a better understanding of the fracture


Depending on the type of the fracture you will be advised operative or non-operative treatment.

Fracture can be of the following two types

  • Displaced fractures are those in which the fracture fragments are separated from each other.
  • Undisplaced or hairline are those in which the fragments are not separated from each other.

Displaced fractures are usually treated by surgery.

Undisplaced fractures and those displaced fractures that can be aligned by manipulation are treated by immobilization in a plaster or splint.

All displaced fractures usually require surgery to prevent in-congruency in the ankle joint. In-congruency can lead to ankle arthritis.

Surgical treatment includes

  • giving an incision to expose the fracture fragments
  • aligning the fracture fragments anatomically
  • fixation of the fragments with stainless steel wires or screws and plates

Ankle Fracture Case Study

ankle fracture x ray

X ray of a 40 year old patient who came after 1 month with an ankle fracture involving both the medial and lateral malleoli. The medial malleoli was fixed with screws only where as the lateral malleoli was fixed with a plate and screws.

ankle fracture surgery

After fixation. The fracture went on to heal uneventfully.


Complications include

  • non-union occurs when the fracture fails to unite
  • mal-union occurs when the fracture unites in a wrong position
  • arthritis of the ankle joint
  • infection
  • loss of movement at the ankle joint

Frequently Asked Questions

How long will it take for the fracture to unite?

The fracture usually unites in 8 to 12 weeks.

What if it fails to unite/heal?

Surgery is usually done it it fails to heal.

What are the chances of non-union of the fracture?

Fracture of the medial malleoli most commonly fails to unite following treatment with plaster. It should only be managed in this way if it is absolutely undisplaced. Even a mildly displaced fracture should be treated operatively to ensure union.

What are the chances of malunion?

Chances of mal-union are more with fractures of the lateral malleoli. Operative treatment is required to correct it.

How much loss of movement is expected?

Loss of movement is more in

  • elderly people treated in a plaster cast
  • people with non or mal-union of the fracture
  • infection

Loss of movement can be minimised by timely surgical fixation of the fracture and early physiotherapy.

Young people rarely have loss of movement of the ankle joint after fracture.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 2nd October 2015.

Further reading....Click Here

Other causes of ankle pain ...

Ankle Arthritis

Ankle Sprain

Pilon Fracture

Tillaux Fracture

Ankle Dislocation

Go back from Ankle Fracture to Ankle Pain


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