Ankle fractures can be a devastating injury and treatment can vary greatly. The ankle joint itself is a complex structure that helps translate motion of the leg to the foot. Without this joint we would never be able to ambulate as we do. Fractures in the ankle can occur in several areas of the bone and can range from a stable and incomplete to comminuted (in several small pieces) and unstable. The ankle joint is of such vital importance in our ability as human beings to walk and run but in today’s world an ankle fracture can also cause us to lose time from work, cost us our ability to drive or exercise.
Anatomy of the Ankle
Understanding the anatomy of the ankle is crucial in being able to identify and treat ankle fractures. The ankle joint itself is made up of 3 main components that include the tibia and fibula (leg bones) and the talus (foot bone). Surrounding these three bones is a capsule, numerous ligaments and tendons that all help to create a dynamic yet stable ankle structure. The ankle joint, like many other joints in the body has a ball and socket “like appearance” that is formed by the lower end of the leg (tibia and fibula) with the dome-shaped talus foot bone. The talus is of vital importance because not only does it help form the ankle joint but also it serves as the connection point of the leg to the foot. The bottom of the talus sits on top of the calcaneus (bone of the heel).
Classification of Ankle Fractures
Danis-Weber Classification:
Classifies the fracture based on the level of injury in relation to the fibula (leg bone).
Type A: Fracture of the fibula below the syndesmosis (the connection between the distal ends of the tibia and fibula).
Type B: Fracture of the fibula at the level of the syndesmosis
Type C: Fracture of the fibula above the level of the syndesmosis
Lauge-Hansen Classification:
Classifies the fracture based on the motion or forces that caused the fracture. It greatly takes into account the position of the foot and ankle just as the injury occurred. There are several Grades and Sequences described.
Supination-Adduction
Pronation-External Rotation
Supination- External Rotation
Pronation-Abduction
Gustilo-Anderson Classification:
While not specific for ankle fractures it is a system of classifying open fractures. Unfortunately, in trauma many ankle fractures can be considered open (when the bone protrudes through the skin). Open fractures leave the bone exposed to the open air and create a high probability of infection.
Type I: Bone exposed, the wound itself measures <1cm
Type II: Bone exposed, the wound itself measures between 1-10cm
Type III: Bone Exposed the wound itself measures >10cm; usually a high-energy injury. It s further divided based on the amount of damage to underlying structures.
A: Adequate tissue for coverage for closure
B: Significant soft tissue loss and bone is stripped of vital periosteum (Protective covering)
C: Significant soft tissue loss, bone is stripped of periosteum, damage to vital neurovascular structures. Often reconstructive surgery is required.
AO Foundation Classification:
Classifies the fracture based on its relation to the syndesmosis (the soft tissue connection between the distal ends of the tibia and fibula). Similar to the Danis-Weber classification but this classification goes into much greater detail to enable better surgical planning.
Infra-Syndesmotic: Fracture below the level of the syndesmosis
Trans-Syndesmotic: Fracture at the level of the syndesmosis
Supra-Syndesmotic: Fracture above the level of the syndesmosis
Symptoms of Ankle Fracture
The symptoms of an ankle fracture can vary from patient to patient and based on the severity of the fracture but there are certain consistencies across all injuries. Majority of patients within the first 24 hours will often experience pain, inflammation, swelling, point tenderness and bruising. With higher grades of fracture the severity of the symptoms will proportionately increase. Symptoms such as numbness (lack of sensation), gross dislocation, compartment syndrome (an extreme swelling that can cause damage to blood supply), open fractures, or loss of a robust vascular supply not only signify a bad ankle fracture, but may indicate a surgical emergency. Prompt diagnosis and treatment is paramount.
Diagnosis of Ankle Fracture
As with any ankle injury the most important first step in diagnosing and treating an ankle fracture is to obtain a proper and timely diagnosis. An appointment with your knowledgeable Union County Orthopaedic Group foot and ankle surgeon is an excellent start. Our staff is willing and able to help put your concerns at ease and get you on the road to recovery.
Treatment
Treating an ankle fracture is an individualized plan that takes great thought and consideration. The most severe ankle fractures often require surgical intervention to restore the correction position and function of the bones and structures of the ankle joint. Surgical intervention may include the use of fixation devices, which include but are certainly not limited to: pins, plates, screws, staples, and external fixators. Surgical patients are kept non-weight bearing for a period of time to allow the ankle to heal before walking or other activities is permitted. For patients with a lesser degree of fracture a period of immobilization may still be required and this may include a cast with crutches or a specialized walking boot. Minor ankle fractures patients will be placed in a specialized walking boot and then put into appropriate physical therapy. Relief from pain and symptoms can take time and it is important to not get frustrated and discuss your concerns with one of our caring and qualified physicians.
