A broken ankle is also known as an ankle "fracture." It is when one or more of the bones that make up the ankle joint are broken. They can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and not able to walk for months. The more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint together and in position.
Broken ankles affect people of all ages. During the last 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due to obesity, sports, increased activity and an active, older population.

Anatomy
Three bones make up the ankle joint -- the tibia (shinbone), fibula (smaller bone of the lower leg) and talus (a small bone that sits between the heel bone and the tibia and fibula. Ankle fractures are named according to the area of bone that is broken.
There are two joints in the ankle area that can be involved in ankle fractures -- ankle joint between the tibia, fibula, and talus and Syndesmosis joint -- between the tibia and fibula, all are held together by ligaments. These ligaments help make the ankle joint stable and prevent injury.

Cause of ankle fractures
Ankle fractures are caused by extreme force going through the ankle, twisting, rotating or rolling your ankle; tripping or falling or a crash from a car accident or major fall can also break your ankle. It is also common if your foot falls in a hole and is twisted.

Symptoms
Because a severe ankle sprain can feel like a broken ankle, every ankle injury should be evaluated by your doctor. Common symptoms for a broken ankle include immediate and severe pain, swelling, bruising, tender to touch, unable to bear any weight on the injured foot and the joint is "out of place".

Diagnosis
At the doctor's office they will ask about your medical history, symptoms you are experiencing, and how the injury occurred, your doctor will also examine your ankle, foot, and lower leg. If your doctor thinks you have an ankle fracture, he or she will order more tests to find out more information about your injury.

Imaging
X-rays are the most common imaging technique used. X-rays can show if the bone is broken and whether they are out of place. They can also show how many pieces of broken bone there are. X-rays may be taken of the leg, ankle, and foot to make sure nothing else is injured. Other tests such as a stress test, computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be ordered.

Treatment
Treatment of an ankle fracture is based on the type and severity of the fracture, where the bone is broken, how many bones are involved and if the bones are out of place. It can be treated with or without surgery.

Non-surgical treatment
At first, the doctor will want you to follow the RICE protocol:
o Rest: Stay off the injured ankle. Walking may cause pain and more injury.
o Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 10 to 20 minutes and then wait at least 40 minutes to an hour before icing again. Cold packs are effective for up to 48 hours.
o Compression: An elastic wrap or bandage can be used to control swelling and hold foot together and in place.
o Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.
Additional treatment options include immobilization as certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint which allows the bone to heal in the right position; and prescription medications to help relieve the pain. The surgeon may prescribe anti-inflammatory drugs or other pain medications.
Most simple fractures heal well with immobilization and non-weight-bearing, not walking on the ankle. You can expect most ankle fractures depending on how severe they are, to take four to eight weeks for the bones to heal completely and up to several months to regain full use and range of motion of the joint. More severe fractures, especially those requiring surgical repair, may take longer to heal. Fractures of any type increase your likelihood of developing arthritis in the affected joint. The more severe the fracture, the higher the risk is.

When surgery is needed
For some ankle fractures, surgery is needed to fix the bone and other soft tissues like the ligaments, if present. The surgeon will select the procedure that is best to fix the injury. Whenever there is surgery, there may be risk of infection, bleeding, pain and even blood clots in the leg. These are not common but can be unlikely once you follow your surgeon's instructions after treatment and surgery.
Although most people return to normal daily activities, except for sports, within three to four months, studies have shown that people can still be recovering up to two years after their ankle fractures. It may take several months for you to stop limping while you walk, and before you can return to sports at your old level. Most people return to driving within nine to 12 weeks from the time they were injured.

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