Compound Ankle Fractures
By Alex Herington, ATC, LAT
Ankle injuries are among the most common types of injuries, ranging from sprains to fractures. However, compound (or open) ankle fractures are less common than the typical ankle sprain and can become far more problematic. In compound ankle fractures, an open wound is caused by a fragment of the involved bone breaking through the skin. If you ever find yourself in this situation, JOI has the most experienced team of orthopedic surgeons in North Florida to get you back on the road to a full recovery.
Anatomy of the Ankle
- The ankle joint is composed of three bones:
- Tibia (Shin bone): Makes up the inside, or medial side of the ankle joint.
- Fibula: Parallels the tibia and makes up the outside, or lateral side of the joint.
- The far ends of the tibia and fibula (the malleoli, the singular form is referred to as the malleolus) come together to form an arch and sit atop the talus.
- The tibia makes up the posterior and medial malleoli, while the fibula makes up the lateral malleolus.
- The talus transfers the forces from the tibia to the heel bone (calcaneus).
- The bones of the ankle joint are held together by a joint capsule and several ligaments that provide stability to the ankle. If any of the ligaments or soft tissues are injured, it may lead to chronic ankle pain and instability.
Cause of Injury for a Compound Ankle Fracture
Compound ankle fractures are caused by a variety of different mechanisms. However, they most commonly occur from a high energy event such as a fall from a height, motor vehicle accident or a sports injury. Often times these injuries will be present with other significant injuries.
Compound ankle fractures require a different treatment than closed (no break in the skin from a bone fragment) fractures. Due to the break in the skin, bacteria and other contaminants from the outside environment may cause an infection. For this reason, it is of the utmost importance to seek emergent medical treatment.
- Since compound fractures pose an immediate threat of infection, cleansing of the wound and administering antibiotics are necessary steps to prevent further contamination of the tissues.
- Following debridement of the tissues, the patient will be placed in a splint until the surgical team determines that it is safe to proceed with the surgery.
- If the wound is more complex than a puncture and the tissue and bones are not yet ready for a permanent implant, an external fixator can be placed on the involved limb to allow to wounds to heal.
- An external fixator is a frame that is attached outside of the limb, to stabilize the bones. Once the wounds are healed and the physician deems the patient ready for a permanent implant, the external fixator will be removed.
- Often times the primary surgical intervention involves fixation with plates and screws to stabilize the fractures and allow to the bones to heal in an anatomically correct position.
- Following the surgery, the patient will be placed in a cast or boot and remain non-weightbearing until the physician determines the bones and incisions have healed and the patient is ready to progress to therapy.
The time it takes for the patient to fully return to activities of daily living can vary greatly depending on the severity of the injury. It is common for patients to experience pain, stiffness, and weakness for several weeks to months after the surgery. Your physician and physical therapist will develop an individualized program specific to the injured body part. This will include range of motion and strengthening exercises to help restore function. The recovery time will also depend on the cooperation of the patient; these exercises are given with the patient’s best interest in mind to help them return to activity as quickly and safely as possible.