Overview

Ankle fractures are common injuries that can range from simple cracks in one bone to complex fractures involving multiple bones and ligaments. The ankle joint bears significant load during walking, running, and jumping, so even minor injuries can have a major impact on mobility. Prompt diagnosis and appropriate management are crucial to restore function, reduce pain, and prevent long-term complications such as stiffness, instability, or arthritis.

At London Bridge Orthopaedics, our orthopaedic surgeons have extensive experience in the diagnosis and management of ankle fractures, offering both conservative and surgical treatment options tailored to each patient’s needs.

Anatomy and Function

The ankle joint is formed where three bones meet — the tibia (shinbone), fibula (outer lower leg bone), and talus (the bone that sits above the heel). These bones are supported by a complex network of ligaments that stabilise the joint while allowing smooth, controlled movement.

When a fracture occurs, it can affect one or more of these bones, sometimes in combination with ligament damage. Because the ankle must balance mobility and stability, any disruption in bone alignment can lead to loss of function or uneven weight-bearing if not treated correctly.

Mechanism of Injury

Ankle fractures typically occur due to trauma that forces the ankle beyond its normal range of motion. The most frequent causes include:

• Twisting or rolling the ankle during sports or daily activities.

• Falling from height or tripping on uneven ground.

• High-energy injuries such as road traffic accidents.

In younger adults, fractures are often linked to high-impact sports or accidents, whereas in older adults, they can result from low-energy falls due to weakened bones or osteoporosis. The specific direction and force of the injury often determine which bones are fractured and whether the ligaments are also torn.

Common Types of Ankle Fracture

There are several classification systems for ankle fractures, but they generally describe the location and pattern of the break.

• Lateral Malleolus Fracture – involving the fibula, this is the most common type of ankle fracture.

• Medial Malleolus Fracture – affects the inner aspect of the tibia.

• Bimalleolar Fracture – involves both the medial and lateral malleoli, often leading to joint instability.

• Trimalleolar Fracture – includes the posterior edge of the tibia in addition to the medial and lateral malleoli; usually a more severe injury.

• Pilon Fracture – a high-impact fracture involving the distal tibia extending into the ankle joint, often seen after major trauma such as a fall from height.

Each of these fractures varies in complexity and may require different treatment approaches to ensure proper joint alignment and stability.

Assessment and Diagnosis

Clinical assessment begins with a detailed history of how the injury occurred, followed by a careful physical examination. The clinician will look for swelling, bruising, deformity, tenderness, and an inability to bear weight. It is also important to check for associated ligament injuries or neurovascular compromise.

Imaging plays a vital role in diagnosis.

• X-rays remain the first-line investigation, helping determine the type and severity of the fracture and whether it is displaced.

• CT scans may be used for more complex or intra-articular fractures to plan surgical repair.

• MRI may be indicated in cases where soft tissue or ligament damage needs further assessment.

Treatment and Management

Conservative (Non-Surgical) Management

Stable, non-displaced fractures can often be treated without surgery. This typically involves immobilisation in a walking boot or cast for six to eight weeks, allowing the bone to heal naturally. Patients are encouraged to elevate the limb to reduce swelling and use crutches for partial or non-weight-bearing, depending on clinical advice. Regular follow-up imaging ensures that the fracture remains aligned during the healing process.

Physiotherapy is usually introduced once the bone has healed sufficiently to restore mobility, strength, and proprioception.

Surgical Management

Surgery is required when fractures are displaced, unstable, or involve the joint surface. The goal is to restore anatomical alignment of the bones and stability of the joint, which is critical for long-term function.

The most common surgical technique is Open Reduction and Internal Fixation (ORIF). This involves repositioning the bones into their correct alignment and securing them with plates, screws, or occasionally tension bands or wires.

• In bimalleolar and trimalleolar fractures, both sides of the ankle may be fixed surgically to prevent malalignment.

• In pilon fractures, reconstruction may require additional bone grafting or external fixation devices, especially when the surrounding soft tissues are damaged.

• Occasionally, arthroscopic-assisted fixation may be used for smaller, less displaced fractures.

Postoperative management includes a period of non-weight-bearing for approximately 6 weeks, followed by gradual return to activity under physiotherapy supervision. Swelling and stiffness are expected but typically improve with guided rehabilitation.

At LBO we have 3 senior Foot and Ankle Surgeons

If you suspect that you have sustained an ankle fracture you should seek professional advice as soon as possible.

Outcomes and Prognosis

The prognosis following an ankle fracture largely depends on the severity of the injury and the quality of the reduction. When treated promptly and effectively, most patients regain good function and mobility.
Surgical treatment generally achieves excellent outcomes, restoring joint alignment and reducing the risk of post-traumatic arthritis. However, complex fractures such as pilon or trimalleolar injuries can take longer to heal and may result in some loss of flexibility or mild ongoing discomfort.

Early rehabilitation plays a key role in optimising recovery. Patients are typically able to resume low-impact activities within three months and higher-impact sports or running within six to twelve months, depending on healing and individual progress.

Complications

Potential complications include infection, wound healing issues, hardware irritation, stiffness, deep vein thrombosis, and in rare cases, non-union or malunion of the bone. The risk of developing arthritis increases if the joint surface was disrupted or alignment was not fully restored.

Frequently Asked Questions

1. How long does it take to recover from an ankle fracture?
   Most simple fractures heal in six to eight weeks, but full recovery of strength and mobility can take up to six months. More complex fractures may require longer rehabilitation.
2. Will I need surgery for a broken ankle?
   Surgery is required if the fracture is unstable, displaced, or involves the joint surface. Your consultant will discuss the most appropriate treatment based on imaging and examination.
3. Can I walk on my ankle after a fracture?
   In most cases, you will need to avoid putting weight on the ankle for several weeks. Weight-bearing is usually introduced gradually under supervision once healing has progressed.
4. What are the risks of ankle fracture surgery?
   Risks include infection, nerve irritation, stiffness, or hardware-related discomfort. These are uncommon and can usually be managed with appropriate follow-up care.
5. When can I return to sport after ankle fracture surgery?
   Return to sport depends on the type of fracture and the success of rehabilitation. Most patients resume low-impact activities after three months and return to competitive sports within six to twelve months.
6. What happens if I don’t treat an ankle fracture properly?
   Untreated or poorly managed ankle fractures can lead to chronic pain, deformity, instability, and arthritis, which may limit mobility and quality of life.

References

1. Court-Brown, C.M. & Caesar, B. (2006). Epidemiology of adult fractures: A review. Injury, 37(8), 691–697.

2. Michelson, J.D. (2015). Fractures about the ankle. Journal of Bone and Joint Surgery (American Volume), 97(12), 1005–1012.

3. NHS. (2024). Broken ankle. Available at: https://www.nhs.uk/conditions/broken-ankle/ (Accessed 15 October 2025).

4. Sanders, D.W., Tieszer, C., & Corbett, B. (2019). Operative versus nonoperative treatment of unstable ankle fractures: a randomized multicentre trial. Journal of Orthopaedic Trauma, 33(9), 449–455.