Ankle Fracture: Types, Symptoms, Causes, Diagnosis, Treatment and Complications

It occurs when one or more of a bone that makes up the ankle joint, and possibly its ligaments, break at or near the joint.

Ankle anatomy

The ankle joint (also known as the talocrural joint ) is the first weight-bearing joint in the body. Your health is key to your body’s movements and balance. The ankle and the surrounding area is made up of:

  • The tibia (the shin, which carries 90 percent of the weight load that the lower leg takes).
  • The fibula (the calf bone, which carries 10 percent of the weight load that the lower leg takes).
  • The talus (the ankle, which articulates with the tibia and fibula at the ankle joint).
  • The lateral collateral ligaments (ankle ligaments that connect to the fibula).
  • The medial collateral ligaments (ankle ligaments that connect to the tibia).

The fibula articulates with the talus (that is, it forms a joint with it) in one place, called the lateral malleolus.

The tibia articulates with the talus in two places: the medial malleolus and the posterior malleolus. It is these malleoli that form the bony bumps on either side of your ankle.

The tibia and fibula form a syndesmosis (that is, a ligament-bone connection) over the talus. The ankle joint and the tibia-fibula syndesmosis are both involved in ankle fracture.

Types of ankle fractures

Ankle fractures can be divided into five main types:

  • Lateral malleolus fracture : The lateral malleolus is the point on the outside of the leg where the fibula articulates with the talus. A lateral malleolus fracture is, strictly speaking, a broken distal fibula.
  • Medial malleolus fracture : A medial malleolus fracture is a fracture of the tibia analogous to a lateral malleolus fracture of the fibula. It is a fracture of the distal tibia.
  • Posterior malleolus fracture : It is very rare that only the posterior malleolus, the actual bony protrusion of the tibia, breaks.
  • Bimalleolar fractures : If two ankles are fractured, it is called a bimalleolar fracture. This is most often a combination of a lateral malleolus and a medial malleolus fracture. This type of fracture will lead to an unstable ankle.
  • Trimaloolar fractures: If all three malleoli (lateral, medial and posterior) have been broken, it is a trimaloolar fracture. This type of fracture will lead to an extremely unstable ankle.

Symptoms of an ankle fracture

While different types of ankle fractures have different symptoms, there are several common symptoms in all types:

  • Extreme ankle pain that can “radiate” to the knee and foot.
  • Swelling in the ankle and occasionally in the leg.
  • Difficulty walking or inability to walk (do not use this as a test as it may make the injury worse).
  • Bruises
  • Ardor.

Symptoms of an ankle fracture can be confused with symptoms of other medical conditions (talus fracture, sprained ankle, or others). Be sure to see a doctor to determine if you have an ankle fracture and to get the proper treatment.


An ankle fracture is the result of excess stress on any or all of the bones in the ankle joint.

The following are the causes of ankle fractures:

  • Ankle sprain : If the foot is twisted to the side, twisting around your ankle.
  • Ankle Overweight – If your foot rolls over to one side while putting considerable weight on it.
  • A fall : if you unexpectedly lose your balance and clumsily try to reach yourself with your feet.
  • Excess movement in the ankle joint : If you try to move the foot too far down in an arc parallel to the leg, as a ballerina would.
  • Extreme impact : if the joint is severely hit, such as if you descend on your feet from a height or if you are in a car accident.

Diagnosis and tests

Your child’s doctor will obtain a history and conduct a thorough examination to look for:

  • Swelling and tenderness
  • Bruises
  • A sprained appearance of the ankle.
  • Discharge or openings in the skin
  • Pulsations

Specialists warn:

“Wounds on the skin are a sign of a possible open fracture. This type of fracture is particularly serious because once the skin breaks open, infection can develop in both the wound and the bone. ‘

“To prevent infection, open fractures require immediate treatment, including irrigation to clean the wound of debris and bacteria, and surgery to repair the fracture.”

If the doctor suspects that the child has a broken ankle, he will order additional tests:

  • X-rays : An X-ray takes a picture of your child’s ankle and can show if a bone is broken.
  • Magnetic Resonance Imaging (MRI) : The MRI scan creates an image of the ankle area with powerful magnets and a computer. The images produced show high-resolution images of bones and soft tissues, such as ligaments. This study is not usually necessary for ankle fractures.
  • Computed Tomography (CT) : This exam tool can create a cross-sectional image of the ankle. It can help determine the exact location of all fractures in complex cases.

Treatment and care of an ankle fracture

Treatment usually involves:

  • Rest: Avoid running, jumping, and other painful activities until pain and swelling go away. The patient may need crutches for a time.
  • Ice Application : Ice applications for 15 minutes at a time to help reduce swelling and relieve pain.
  • Compression – Wearing an elastic bandage around the ankle can help keep the swelling down.
  • Elevation: Elevating the ankle on a chair or pillow while the ankle is swollen can help reduce swelling.

Further treatment depends on the class and severity of the fracture. If the broken bone is crooked, your doctor will straighten it. Your child will first be given medicine so that the straightening will not be painful. Sometimes surgery is needed to put the bones in the correct position.

In some cases, your doctor may place your child’s ankle in a cast, splint, removable boot, or Aircast to keep it from moving while it heals.

Surgery is sometimes necessary to align the bones and growth plates to position the bones for healing. Small incisions and percutaneous techniques are used whenever possible.

Growth plate fractures are recommended to be closely monitored by a physician to ensure adequate long-term results.

This is because these fractures can lead to an ankle deformity if growth is uneven. Parents should schedule regular follow-up visits with their doctor for at least one year after the fracture.

Complicated fractures may need to be followed until the child reaches skeletal maturity.


Without proper intervention and medical care, an ankle fracture can lead to arthritis. You are at especially high risk for arthritis if your ankle looks deformed after your injury. If the break is very severe, you may see a bone sticking out of your skin.

If this is the case, you should seek immediate medical attention, as this type of ankle fracture can lead to a serious infection.