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Different Types of Ankle Fractures and Treatment Options

Mar 23, 2023
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You have three main bones in your ankle, and you can break any or all of them by twisting, rolling, tripping, or jamming the joint. The best treatment depends on which bone is fractured and how badly. Here’s what you need to know about broken ankles.

Car accidents and sports injuries are notorious for causing ankle fractures, but you don’t have to be a crash survivor or an athlete to get one. Tripping on a curb, missing the last step on your staircase, or falling off of a ladder can do the trick, too. Although there are countless potential causes, there are five main types of ankle fractures.

Each type requires specialized care based on the location and severity of the break. Texans in and around Austin and Cedar Park trust the future of their ankle health and function to Dr. Pedro Cosculluella and Dr. Andrew Ebert, our board-certified orthopedic surgeons who specialize in repairing complex ankle fractures at Austin Foot & Ankle Institute

Here, we explain the different types of ankle fractures and the treatments that doctors recommend for each.

Get to know your ankle bones

Before diving into fracture types and treatments, let’s look inside your ankle and get familiar with its anatomy. You have three main bones in your ankle: the tibia (shin bone), the fibula (smaller bone in your lower leg), and the talus (the small bone that sits under the tibia and fibula above your heel bone).

Your tibia has two parts: the medial malleolus (the bump of your inner ankle) and the posterior malleolus (the back side of your tibia). The big bump on your outer ankle is the lower end of the fibula, called the lateral malleolus. 

We’re highlighting these medical terms because they come into play when we diagnose and treat your ankle fracture. Your doctor names the type of fracture based on the bones involved in the injury.

Signs of an ankle fracture

An ankle fracture hurts — a lot — but so do other types of ankle injuries and conditions such as sprains, strains, and arthritis, and the symptoms often overlap, making self-diagnosis impossible. In addition to severe pain, ankle fractures typically cause a variety of symptoms, including:

  • Swelling
  • Discoloration and bruising
  • Instability
  • Inability to bear weight

Depending on the type of injury, you may also see some deformity in the joint and notice numbness or coolness in your foot. 

Drs. Cosculluela and Ebert perform a thorough physical exam and talk with you about the nature of your injury and your symptoms. If they suspect a fracture, they take an X-ray to view the structure of your ankle bones and may order more specialized imaging tests, such as a CT scan, bone scan, or MRI.

Types of ankle fractures and their treatments

We classify your ankle fracture based on if and how the break moves your bones from their original position. A nondisplaced fracture doesn’t move the bones at all; a displaced fracture moves the bone pieces and separates them; an open fracture pushes outward through your skin and requires emergency medical attention. 

In addition to these classifications, we also evaluate your fracture based on the bones involved. Here are the different types of ankle fractures, and this is where the medical names we mentioned above come in handy. 

1. Medial malleolus fracture

If you break your medial malleolus, the inside bump on your ankle, the severity of the fracture dictates the treatment. If the medial malleolus fracture is nondisplaced, we can usually treat it with a cast or walking boot. However, if you have a displaced medial malleolus fracture, it may require surgical repair with metal screws to reattach the pieces.

2. Lateral malleolus fracture

The prominent bump on the outside of your ankle, the lateral malleolus, follows a similar treatment protocol to the medial malleolus — nondisplaced fractures take a cast or boot, and displaced fractures need surgery. We may need to use a metal plate in addition to the screws to hold the bone fragments in place.

3. Posterior malleolus fracture

Minor fractures on the back side of your tibia, the posterior malleolus, typically don’t require surgery. You have to keep your ankle immobile for a while to allow it to heal, so a walking boot or short cast is in your future. Surgery is only necessary if the fracture is large or has displaced the bones.

4. Bimalleolar fractures

If you break both the medial and lateral malleolus bones, an injury called a bimalleolar fracture, your ankle is severely damaged and likely dislocated. Expect to undergo surgery with this type fracture, involving plates and screws. Rare cases of a stable bimalleolar fracture may only require immobilization.

5. Trimalleolar fractures

A trimalleolar fracture involves all three malleolus bones — medial, lateral, and posterior — and almost always requires surgery.

Less than 1% of ankle fractures involve the talus bone, and when they occur, they’re almost always due to the impact of a car crash. 

If you suspect an ankle fracture, contact us at Austin Foot & Ankle Institute immediately. Proper diagnosis and prompt treatment can get you back on your feet and help you prevent future injuries and chronic ankle problems.