I Broke My Ankle, What Do I Do?
Ankle Fractures: Stable and Unstable Lateral Malleolus Fractures, Bimalleolar, Trimalleolar, and Distal Fibular Avulsion Fractures
A broken ankle can be painful, frightening, and confusing. One of the most important questions after an ankle fracture is whether the ankle is stable enough to heal without surgery or whether the bones and ligaments are too unstable to heal in the correct position. Treatment may range from a walking boot and activity modification to surgery using plates and screws. In selected patients, minimally invasive ankle fracture fixation may also be an option.
If you have broken your ankle in Greenville, South Carolina, evaluation by a fellowship-trained foot and ankle orthopedic surgeon can help determine the severity of the injury and the best treatment for your specific fracture.
What Is an Ankle Fracture?
The ankle is formed by three bones: the tibia, fibula, and talus. The bump on the outside of the ankle is called the lateral malleolus and is the lower end of the fibula. The bump on the inside is the medial malleolus, which is part of the tibia. The back portion of the tibia is called the posterior malleolus.
Ankle fractures can occur from a simple twisting injury, a fall, a sports injury, or a high-energy accident. Some fractures are small and stable, while others can cause the ankle joint to become displaced or unstable. X-rays are typically used to determine the fracture pattern and whether the ankle remains properly aligned.
What Is a Lateral Malleolus Fracture?
A lateral malleolus fracture is a break in the lower portion of the fibula on the outside of the ankle. This is one of the most common types of ankle fracture.
The important distinction is that a lateral malleolus fracture can be either stable or unstable. Two patients can have fractures of the lateral malleolus that look similar on an X-ray but require very different treatment.
Stable Lateral Malleolus Fracture
A stable lateral malleolus fracture means that, despite the broken fibula, the ankle joint remains properly aligned and the supporting ligaments and syndesmosis are stable enough to maintain that alignment.
These fractures can often be treated without surgery. Treatment may include:
A fracture boot or walking boot
Limited or protected weight bearing initially
Crutches as needed
Elevation and treatment of swelling
Gradual progression of weight bearing
Range-of-motion exercises when appropriate
Physical therapy to restore strength, balance, and mobility
A cast or boot may be used until the fracture has adequately healed. The exact length of immobilization and when you can put weight on the ankle depend on the fracture pattern and follow-up examination and X-rays.
One of the most important things to understand is that “stable” does not simply mean the bone is not very displaced. Your orthopedic surgeon also needs to determine whether the ankle joint itself is stable. In some cases, additional imaging or stress/weight-bearing X-rays may be used to help make that determination.
Unstable Lateral Malleolus Fracture
An unstable lateral malleolus fracture occurs when the ankle cannot reliably maintain its normal alignment because of displacement, ligament injury, syndesmotic injury, or associated fractures.
An unstable fracture may initially appear to be an isolated fibula fracture, but the ankle can still be unstable because important ligaments have been injured.
When the ankle is unstable or out of proper alignment, surgery is commonly recommended to restore the position of the ankle and hold the fracture securely while it heals.
The goal of surgery is not simply to “fix the fibula.” The goal is to restore the normal alignment and stability of the ankle joint. Improper alignment can increase the risk of pain, stiffness, and post-traumatic ankle arthritis.
What Is a Bimalleolar Ankle Fracture?
A bimalleolar ankle fracture involves fractures of both sides of the ankle—typically the lateral malleolus of the fibula and the medial malleolus of the tibia.
Because two sides of the ankle have been fractured, these injuries are frequently unstable. However, treatment is individualized based on the actual alignment of the ankle and the patient's overall health.
When surgery is necessary, the fractured bones are repositioned and stabilized with plates and screws. This is commonly called open reduction and internal fixation (ORIF).
What Is a Trimalleolar Ankle Fracture?
A trimalleolar ankle fracture involves all three major malleolar regions:
The lateral malleolus
The medial malleolus
The posterior malleolus
These fractures are generally more severe and are frequently unstable. The posterior malleolus fracture can also affect the stability and surface of the ankle joint.
Because trimalleolar fractures can significantly disrupt the ankle joint, surgery is often recommended to restore alignment and stability. The exact surgical plan depends on the size and location of the fracture fragments, the position of the ankle, and the condition of the surrounding ligaments and soft tissues.
What Is a Distal Fibular Avulsion Fracture?
A distal fibular avulsion fracture is a small fracture in which a ligament pulls a tiny piece of bone away from the distal fibula.
These injuries can occur with a significant ankle sprain and are sometimes referred to as avulsion fractures.
Because the fracture fragment is usually small, these injuries are frequently treated similarly to a severe ankle sprain rather than with traditional fracture surgery. Treatment may include a walking boot, activity modification, temporary protection from weight bearing, and rehabilitation.
However, it is still important to have the injury properly evaluated. A small avulsion fracture can sometimes occur along with other ligament or ankle injuries that need additional treatment.
When Does an Ankle Fracture Need Surgery?
The decision to perform ankle fracture surgery is based primarily on stability and alignment, rather than simply the name of the fracture.
Surgery is more likely when:
The ankle joint is displaced
The fracture is significantly displaced
The ankle is unstable
Multiple malleoli are fractured
The syndesmosis is injured and unstable
The ankle has dislocated
The bones cannot be maintained in proper alignment without fixation
The fracture is open or the bone has broken through the skin
The standard operation for many unstable ankle fractures is open reduction and internal fixation, or ORIF. Plates and screws are used to restore and maintain the alignment of the fractured bones while they heal.
Minimally Invasive Ankle Fracture Fixation
Not every ankle fracture requires a large incision.
In carefully selected patients, minimally invasive or percutaneous ankle fracture fixation may be possible. This approach uses smaller incisions and specialized instruments to reduce and stabilize the fracture while minimizing disruption to the surrounding soft tissues.
The exact technique depends on the fracture pattern. Minimally invasive fixation can involve placing screws, plates, or other fixation devices through smaller incisions when the fracture can be safely reduced and stabilized this way. Percutaneous fracture fixation is an established technique for selected fractures.
It is important to understand that minimally invasive does not mean appropriate for every fracture. Complex or significantly displaced fractures may still require traditional open surgery to safely restore the anatomy.
What Should You Do After Breaking Your Ankle?
If you have just injured your ankle and suspect a fracture, it is important to protect the ankle and avoid putting unnecessary weight on it until you have been evaluated.
A typical evaluation may include:
X-rays: These show the fracture pattern and help determine whether the ankle is aligned.
Physical examination: Your surgeon will evaluate swelling, skin condition, circulation, sensation, and ankle stability.
Additional imaging: In more complex fractures, a CT scan may occasionally be needed to better understand the fracture pattern and plan treatment.
The most important question is not simply “Is my ankle broken?” It is:
“Is my ankle fracture stable, and what treatment will give me the best chance of healing in the correct position?”
Finding an Ankle Fracture Specialist in Greenville, SC
If you have a broken ankle in Greenville, South Carolina, seeing a surgeon who specializes in foot and ankle conditions can be especially valuable when the fracture may be unstable or require surgery.
Michael Sims, MD, is a board-certified, fellowship-trained orthopedic foot and ankle surgeon in Greenville, South Carolina. Dr. Sims completed his orthopedic surgery residency at Greenville Health System and completed a Foot and Ankle Surgery fellowship at the Campbell Clinic in Memphis, Tennessee. His practice includes treatment of fractures and trauma as well as minimally invasive foot and ankle surgery.
Dr. Sims evaluates both non-surgical and surgical treatment options for broken ankles, including ankle fracture ORIF and minimally invasive techniques when appropriate.
Broken Ankle Treatment in Greenville, South Carolina
Whether you have an isolated lateral malleolus fracture, an unstable fibula fracture, a bimalleolar ankle fracture, a trimalleolar fracture, or a distal fibular avulsion fracture, the correct treatment depends on the stability and alignment of your ankle.
Some fractures heal very well in a walking boot without surgery. Others require plates and screws to restore the ankle to its proper position. In selected cases, minimally invasive ankle fracture fixation can provide another surgical option.
Getting the right diagnosis early can help you understand your options and avoid problems from an ankle fracture healing in the wrong position.
If you have broken your ankle in Greenville, SC, consider evaluation by a fellowship-trained foot and ankle orthopedic surgeon such as Michael Sims, MD, who specializes in both surgical and non-surgical treatment of ankle fractures.
Common Questions About Ankle Fractures
Can a lateral malleolus fracture heal without surgery?Yes. Many stable lateral malleolus fractures can be treated with a boot or cast and close follow-up. The key issue is whether the ankle remains properly aligned and stable.
Does every bimalleolar or trimalleolar fracture require surgery?No fracture should be labeled for surgery based solely on the name. However, bimalleolar and trimalleolar fractures are often unstable, making surgery more common. The decision depends on the specific fracture and ankle alignment.
How are unstable ankle fractures fixed?Many unstable ankle fractures are treated with plates and screws to restore the broken bones to their proper position and maintain stability during healing.
Can ankle fractures be fixed through small incisions?In selected cases, minimally invasive or percutaneous fixation may be possible. The fracture pattern and soft-tissue condition determine whether this is a safe and appropriate option.
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