The ankle joint is made up of three bones that articulate together: tibia, fibula and talus. The ends of the tibia and fibula form the inner and outer malleolus, the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule and is filled with synovial fluid to enable smooth, frictionless movement.

Symptoms

Common symptoms of an ankle fracture include:

• Immediate and severe pain
• Swelling
• Inability to weight bear leading to impaired mobility
• Blood may accumulate around the joint (hemarthrosis)
• Deformity, depending on severity of fracture or dislocation

Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and confirmed by X-ray and CT scan of the injured area. It can be difficult to differentiate a broken bone from other conditions such as a sprain, dislocation, or tendon injury without X-ray. 

In some cases an ankle stress test is performed by applying pressure on the ankle with special X-rays to check the stability of the fracture to determine if surgery is required.

An MRI scan may be required in complex cases where detailed evaluation of the ligaments is required.

Treatment Options

Immediately following ankle injury and prior to seeing a doctor, ice packs should be applied to the affected ankle and the foot should be elevated to minimise pain and swelling. Treatment of an ankle fracture depends upon the type and stability of the fractured bone. 

Types of ankle fractures are:

• Lateral, medial or posterior malleolus fracture
• Bimalleolar fracture - both lateral and medial malleolus bones are fractured
• Trimalleolar fracture - lateral, medial and posterior bones are fractured
• Syndesmotic injury - high grade ankle sprain, usually not a fracture but can be treated as one.

Non Operative Treatment

Treatment starts with non operative methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed. In non operative treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint for at least two to three weeks.

Surgery

With surgery, the fractured bone is accessed by making an incision over the ankle area, then specially designed plates are screwed onto the bone to realign and stabilise the fractured parts. The incision is then sutured closed and the operated ankle is immobilised with a splint or cast. Recovery from surgery can take up to six weeks of initial healing and participation in physiotherapy for an additional two to three months before you can fully return to activities.