Unfortunately, with the slippery conditions, ankle fractures are all too common during the winter months. In fact, in the United States 250,000 patients will suffer from a broken ankle each year. Elderly women are at the greatest risks due to osteoporosis, which leads to weakening of bones. Once the bone quality has softened, even a small fall may result in a significant fracture.
If you are 1 of the 250,000 Americans that has sustained an ankle fracture this past year, you probably have already been to the Emergency Department. There, the doctor would have taken x-rays and/or CT scan to determine the extent of your injury. At that point, if you were told that your fractures were not lined up, the doctor will try to reduce (move the fracture fragments back in line) by pulling on the ankle; you would have been sedated for this part. If the fracture fragments can be re-aligned shortly after the injury, the prognosis will be better.
There are two broad categories of ankle fractures, stable and unstable. A stable ankle fracture, means that you would have only broken one of the two bones in your ankle, either the inside bone (tibia) or outside bone (fibula). It is more common to have just the outside bone broken (fibula) versus having just the inside bone broken (tibia). With a stable ankle fracture, surgery may be able to be avoided depending on the alignment of the fracture. If surgery is not needed you will wear a cast for 4-8 weeks and remain non-weightbearing during this time.
If you have an unstable ankle fracture, which means that both the outside (fibula) and inside (tibia) ankle bone are broken, you may require surgery to repair the fracture. However, surgery may need to be delayed 1-2 weeks depending on how quickly you received medical treatment, which is why it is important to always seek medical attention immediately after an injury. Surgery cannot be done on ankle fractures that are too swollen or if blisters have formed. Surgery will consist of putting hardware, such as titanium plates and screws to hold the fracture fragments in line. A commonly asked question regarding the hardware is will it set off airport alarms or store security systems and the answer is no. The surgery will take about 1-3 hours depending on the extent of the injury. With the fractures aligned, the healing process will begin, which it takes 6-8 weeks for bone to heal. During this time you will be non-weightbearing and in a cast. After healing, you will go through a course of physical therapy or at home exercises to regain your ankle range of motion and strength.
Complications of any fracture is non-healing, which the risk is significantly lowered with being a non-smoker and being 100% diligent in putting no weight on the ankle. Painful hardware, which this is not too complicated, because once the bone has healed, the hardware can be quickly removed in the operating room. Not every patient will have hardware that bothers them; often times patients forget that they even had a plate and screws put in their ankle. Lastly, with any injury, you can develop post-traumatic arthritis due to damaging the cartilage surfaces. There are various treatments for post-traumatic arthritis, but it can be lessened by not delaying treatment and the doctor will decrease it by re-aligning your fracture well either by casting or surgery. Be careful this winter and if you are 1 of the 250,000 unlucky people to take a fall go to the Emergency Department for further evaluation.