A fracture of the ankle involving the lateral malleolus, the medial malleolus, or the posterior malleolus is referred as a malleolar fracture. In other words, the malleolar fracture is a fracture in the ankle that results when one or more bones that make up the ankle joint are broken.
Anatomy Of The Ankle
The ankle joint is made up of three bones that are tibia, fibula, and talus. The tibia is your shinbone and fibula is the smaller bone of the lower leg. A small bone that lies between the heel bone and the tibia and fibula is known as the talus.
The end of the fibula is referred as lateral malleolus which carries 10 percent of your body weight. However, the inside part of the tibia is termed as medial malleolus and the end of the tibia as posterior malleolus. About 90 percent of your body weight is carried by tibia. All three bones play a crucial role in moving, controlling and stabilizing the ankle and the foot. A malleolar fracture is the three-part break of the ankle that affects these three specific areas of the ankle. Because of where this fracture occurs, it is considered more unstable than other fractures.
Causes and Symptoms
Sometimes a simple trip or fall can also lead to a fractured ankle. However, major car accidents, sports injury and other similar mishaps can also cause a malleolar fracture. A severe ankle sprain can feel the same as a broken ankle, and hence every ankle injury should be diagnosed by a physician. Here are some common symptoms of a malleolar fracture.
- Immediate and severe pain in the ankle
- Swelling and bruising in the ankle
- Incapable of putting weight on the damaged ankle
- The ankle looks out of place
- The ankle looks deformed
After performing a physical examination, if the doctor suspects that there is a fracture in the ankle, additional tests are carried out to gain more information. An X-ray is one of the common ways to detect the fracture and figure out whether a bone is broken or there is a displacement.
To determine whether a surgery is required for the treatment, a special X-ray known as stress test is conducted. A CT scan is considered for further evaluating the injury especially if the fracture has extended to the ankle joint. MRI or Magnetic resonance imaging scan is suggested when there is a need for high-resolution images of the anklebones and soft tissue. This test is recommended to examine the ankle ligaments.
Surgery is usually recommended for the treatment of a malleolar fracture. The nonsurgical treatment is considered only if there is a risk due to other health complications. Sometimes over-the-counter prescription or pain medications are recommended by doctors. The surgical procedures are used to stabilize the ankle and to speed up the healing process.
There are also some complications that result from ankle fractures. Malunion is one of the major issues that can arise when the bones move and heal out of place after a malleolar fracture. It can result in an unstable ankle and eventually lead to arthritis. Infections, bleeding, blood vessel damage, blood clots in the leg, damage to nerves and tendons are other complications associated with a malleolar fracture.
It can take up to six weeks for recovery. However, the damaged tendons or ligaments may take longer to heal. Also, the recovery speed varies from person to person depending on pre-existing health conditions, the severity of the injury and the extent of surgery.
Physical therapy and home exercise can help the patient in strengthening the ankle. It can take time for the muscles to be strong enough to walk without a limp. It is not unheard of that it takes one full year of proper rehabilitation to fully heal the ankle after a malleolar fracture.