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Ankle Fracture and Syndesmotic Injuries
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What are Ankle Fractures and Syndesmotic Injuries?
An ankle fracture refers to a break in one or more of the bones that constitute the ankle joint, namely the tibia, fibula, and talus. These fractures can range from minor hairline fractures in the bone to severe comminuted fractures that disrupt the joint.
Syndesmotic injuries often occur alongside ankle fractures or independently, involving damage to the syndesmosis—a fibrous joint held together by ligaments. They typically result from high-ankle sprains, where the ligaments connecting the tibia to the fibula (lower leg bones) are stretched or torn.
Types of Ankle Fractures
Ankle fractures are categorised based on the specific bones involved and the break pattern. The common types include:
- Lateral Malleolus Fracture: This is the most common type of ankle fracture, involving a break in the fibula, the smaller of the two bones in the lower leg.
- Medial Malleolus Fracture: This involves a break in the medial malleolus, the bony protrusion on the inner aspect of the ankle, which is part of the tibia.
- Posterior Malleolus Fracture: This type of fracture affects the posterior malleolus, the back portion of the tibia, at the ankle joint level.
- Bimalleolar Fractures: These occur when there are breaks in both the medial and lateral malleoli.
- Trimalleolar Fractures: This more severe fracture involves all three malleoli – the ankle’s lateral, medial, and posterior aspects.
- Pilon Fractures: These are fractures of the distal end of the tibia, affecting the weight-bearing surface of the ankle joint. They are often associated with high-energy impacts.
Causes
Various causes, often involving sudden or unnatural movements, can lead to ankle fractures and syndesmotic injuries. The primary causes include:
- Twisting or Rolling of the Ankle
This is a common cause of ankle fractures, especially lateral malleolus fractures. It typically occurs during activities like walking on uneven surfaces, sports, or accidental missteps. - Falls
Falling in a way that puts extreme pressure on the ankle can lead to fractures, particularly in older adults or those with weakened bone health. - Impact or Trauma
Direct impacts, such as in car accidents or heavy falls, can cause severe ankle fractures or syndesmotic injuries. - Overuse
Stress fractures can occur from repetitive activities or overuse, often seen in athletes. - Osteoporosis
This condition weakens bones, making them more susceptible to fractures, even with minor stress or falls.
Symptoms
The symptoms of ankle fractures and syndesmotic injuries can vary depending on the severity and type of injury but typically include:
- Pain
This is usually immediate and can range from mild to severe, often increasing with movement or pressure. - Swelling and Bruising
Swelling and bruising around the ankle are common and can develop quickly after the injury. - Visible Deformity
In severe fractures, there may be an obvious deformity of the ankle, such as a bone protruding from the skin or the ankle appearing out of place. - Tenderness
The injured area may be tender to touch. - Restricted Range of Motion
Ankle movement may be limited or extremely painful.
Diagnosis
Diagnosing ankle fractures and syndesmotic injuries involves a combination of evaluation and imaging studies. The typical diagnostic process includes:
- Physical Examination
The orthopaedic surgeon will examine the injured ankle, assessing for pain, swelling, bruising, and range of motion. - Medical History
A review of how the injury occurred and any previous ankle injuries is important. - X-rays
These are the primary imaging tests used to identify fractures and assess their severity. They can show the location and pattern of the fracture. - Computed Tomography (CT) Scan
A CT scan may be used for more complex fractures to get a detailed image of the ankle bones. - Magnetic Resonance Imaging (MRI)
MRI may be recommended to evaluate soft tissue injuries, including damage to ligaments and syndesmosis. - Stress Tests
These might be performed to assess the ankle’s stability and ligament integrity.
Non-Surgical Treatment Options
Non-surgical treatment may be appropriate for certain types of ankle fractures and syndesmotic injuries, especially those less severe or where the bones remain properly aligned. These options include:
Rest and Immobilisation
Keeping the ankle immobile in a cast or splint allows the bones to heal naturally.
Ice and Elevation
Applying ice and keeping the ankle elevated can help reduce swelling and pain.
Medications
Pain relievers and anti-inflammatory drugs can be used to manage pain and swelling.
Physical Therapy
After the initial healing phase, physical therapy is essential to restore strength, flexibility, and range of motion.
Bracing or Supportive Devices
These may be used for additional support as the ankle heals.
Surgical Treatment Options
Surgery may be necessary for more severe ankle fractures or syndesmotic injuries, particularly when there is significant displacement of the bones or instability of the ankle joint. Surgical options include:
- Open Reduction and Internal Fixation (ORIF)
This is the most common surgical procedure for ankle fractures. It involves realigning the fractured bones and securing them with screws, plates, or rods. - Syndesmotic Screw Fixation
For syndesmotic injuries, screws may be placed between the tibia and fibula to maintain the correct position and allow ligaments to heal. - External Fixation
An external frame may be used temporarily to stabilise the bones in cases with severe swelling or soft tissue damage. - Arthroscopy
This minimally invasive surgery can be used to assess and repair damage to the joint and associated structures. - Bone Grafting
In cases of bone loss or severe fractures, bone grafting may be necessary to promote healing.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Strategies
While not all ankle fractures and syndesmotic injuries can be prevented, some strategies can help reduce the risk. These include:
- Wearing Appropriate Footwear: Shoes that provide good support and fit well can help prevent ankle injuries, especially during sports or physical activities.
- Maintaining Strength and Flexibility: Regular exercises to strengthen the muscles around the ankle and improve flexibility can help stabilise the joint.
- Avoiding Uneven Surfaces: Being cautious when walking or running on uneven ground can prevent falls and twisted ankles.
- Improving Balance and Coordination: Balance and coordination exercises can reduce the likelihood of falls, especially in older adults.
- Regular Bone Health Check: Regular bone density tests and appropriate calcium and vitamin D intake can help maintain bone strength for those at risk of osteoporosis.
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Frequently Asked Questions (FAQs)
How Long Does It Take for an Ankle Fracture to Heal?
The healing time for an ankle fracture varies depending on its severity and type. Generally, it may take 6 to 12 weeks to heal sufficiently to allow weight-bearing activities.
Can You Walk on a Fractured Ankle?
Walking on a fractured ankle is not recommended as it can impede healing and potentially worsen the injury. To avoid putting weight on the injured ankle, crutches or a walker may be necessary.
Do All Ankle Fractures Require Surgery?
Not all ankle fractures require surgery. Some fractures, particularly those where the bones are still properly aligned, can heal with non-surgical treatment methods like immobilisation and physical therapy.
When Can I Return to Sports After an Ankle Fracture?
The timing for returning to sports depends on the severity of the fracture and the treatment received. It is important to fully rehabilitate the ankle and gain medical clearance before resuming sports activities.