Diagnostics
If there is reasonable suspicion of an ankle fracture, an X-ray of the ankle joint should always be taken in two planes (from the front (a. p. -image) and from the side). This is important to confirm the suspected diagnosis, to assess the extent and type of fracture, to rule out other injuries and to plan therapeutic measures. If an injury to the fibula near the knee joint is suspected (Maisonneuve fracture), the entire lower leg should be X-rayed in two planes (sometimes overlooked!). If the tibial tibia bearing the ankle joint (pilon tibiale) is involved in the fracture, computer tomography (CT) of the ankle joint may be useful for better fracture assessment and therapy planning.
Treatment with OP
Surgical treatment of an external ankle fracture is generally recommended, unless the fracture is very uncomplicated or the risks of surgery are too high for the respective patient. There are guidelines for deciding when a fracture of the outer lower leg bone (fibula) should be treated surgically, but individual assessment should not be missing. If the fracture is at the level of the ligament that connects the two bones in the lower leg at the lower end and ultimately holds the ankle together (syndesmosis), and if this ligament-like connection itself is partially damaged by a non-continuous tear, for example, this would be a reason for surgical treatment.
This constellation is then called in medicine an outer ankle fracture of the “Weber type B”. Another case, namely a “Weber type C” fracture is also a reason for surgery. In this case the ligamentous connection (syndesmosis) is completely torn, the fracture is located above the syndesmosis mentioned and a thin skin (membrane) between the two lower leg bones is also torn.
Another case for surgery is a simple fracture below the syndesmosis without further damage, if the two fractions have shifted too far from each other (dislocated fracture) and the fracture would not heal normally by natural means. Then the bones must be surgically repositioned in their original position. The operation itself and/or the aids used also depend on the type of fracture, any ligament injury and the stability of the ankle.
Displaced bone parts are usually placed together and connected and stabilized with screws or metal plates (fixation). It is important to restore the exact length of the outer bone, otherwise the foot will be malpositioned in the long term. Torn ligaments are sutured together and, if necessary, fixed with an additional “set screw”, which is removed after about six weeks.
For complicated fractures, such as type B or C fractures mentioned above, “traction screws” and metal plates are often used in combination. In contrast to set screws, lag screws can exert pressure on the fracture gap by permanently pressing the two bone parts together, which stimulates bone healing. Plates, on the other hand, stabilize and support the fracture from the side, thus preventing the bone parts from shifting during the healing process.
In serious cases, such as an open fracture in which the bone parts protrude from the skin or a comminuted fracture in which many small free bone parts are visible, the temporary use of a so-called “external fixator” may also be necessary, which like a scaffold holds the fracture parts in place from the outside. In any case, it is only used for the first emergency treatment, which is always followed by a definitive, final treatment as described above. Read more about the operation of an external ankle fracture here.
