A broken ankle, medically known as an ankle fracture, involves a break in one or more of the three bones that form the ankle joint: the tibia, the fibula, and the talus. The decision to treat a broken ankle with surgery depends entirely on the severity of the injury and the stability of the joint. Some ankle breaks are minor enough to heal with simple immobilization, while others require surgical repair to ensure proper function and alignment.
Classifying the Ankle Break
Doctors must first determine the precise nature and severity of the fracture to guide treatment. The primary imaging tool is the X-ray, which allows physicians to visualize the bone fragments and their position. For more complex breaks, a Computed Tomography (CT) scan provides a detailed, three-dimensional view of the injury.
Severity is determined by the stability and alignment of the joint. Stability refers to whether the ankle joint is held securely, often compromised if ligaments are torn. Alignment is assessed by checking for displacement, which occurs when bone fragments have shifted significantly out of their normal position.
Fractures are also classified by the number of bony knobs, or malleoli, that are broken. A unimalleolar fracture involves a break in only one malleolus, typically the fibula. Bimalleolar fractures involve two malleoli, and trimalleolar fractures involve all three, including the posterior part of the tibia. The greater the number of broken bones, the higher the likelihood that the joint is unstable and requires surgery.
When Surgery is Necessary
Surgery is required for fractures that threaten the long-term function of the ankle joint. This includes unstable fractures where the ankle joint cannot maintain proper alignment. Displaced fractures, where bone fragments are misaligned, also require surgical intervention to restore the correct anatomy.
The involvement of multiple malleoli, such as bimalleolar or trimalleolar breaks, almost always mandates surgery because the joint’s structural integrity is compromised. Immediate surgery is also required for an open fracture, where the broken bone has pierced the skin, carrying a high risk of infection.
The procedure used to stabilize these severe injuries is called Open Reduction and Internal Fixation (ORIF). Open reduction involves a surgeon making an incision to reposition the bone fragments into their correct anatomical alignment. Internal fixation then uses hardware, such as metal plates, screws, or pins, to hold the bones firmly in place while they heal. The goal of ORIF is to ensure the ankle heals in a position that minimizes the risk of future complications, like post-traumatic arthritis.
Non-Surgical Treatment Options
Many ankle fractures can be treated successfully without surgery, particularly those that are stable and non-displaced. A stable fracture is one where the broken bones remain aligned, and the joint is intact enough to resist movement. These are often simple, isolated breaks, such as some unimalleolar fractures.
The primary non-surgical treatment is immobilization, which involves placing the ankle in a cast or a removable walking boot to restrict movement and allow the bone to heal. If the bone is slightly out of position but the injury is stable, a physician may perform a closed reduction. This involves manually realigning the bones without a surgical incision before applying the cast.
Patients are restricted from bearing weight on the injured ankle for several weeks to prevent the fracture from shifting. Doctors conduct follow-up X-rays throughout the healing process to confirm the fracture remains in the correct alignment within the cast or boot. Non-surgical management is chosen when the risk of the fracture displacing during healing is low.
Recovery Timeline and Expectations
The recovery process for a broken ankle is often lengthy and depends on the injury’s severity and the type of treatment. For both surgical and non-surgical paths, the initial phase involves a period of non-weight-bearing, typically lasting between six and twelve weeks. During this time, the bone fragments begin to knit together, and the patient uses crutches, a walker, or a knee scooter to remain mobile.
Once X-rays show sufficient bone healing, the patient gradually transitions to partial weight-bearing, often in a walking boot. Physical therapy (PT) is the next step, sometimes beginning with gentle range-of-motion exercises as early as two weeks after surgery or cast removal. The focus of PT is to regain strength, flexibility, and the full range of motion lost during immobilization.
Full recovery, meaning a return to all normal activities and sports, can take a significant amount of time. While some stable fractures may feel functional within three to four months, complex fractures requiring ORIF can take six months to a full year for complete recovery. Adherence to physical therapy and a gradual return to activity are necessary to achieve the best long-term outcome.