Fracture of the outer ankle

Fracture of the outer ankle (malleolar fracture, ankle fracture) is a relatively common injury and is characterized by the fracture of the bone protrusion on the outer ankle: the outer ankle.

The lower leg is formed by two adjacent tubular bones: fibula and tibia.
The fibula is located in the lower, outer area of the leg and articulates with the shin at knee level, and forms the upper ankle joint at ankle level with the shin and the lower ankle bone.

During certain movements, such as touching down after a jump and especially when the ankle joint is sprained, considerable force is exerted on the outer ankle (malleolus lateralis).
If this force is particularly strong, the outer ankle can break.

The fracture can occur in the elderly, but it can also affect young people.
Often an outer ankle fracture occurs along with a sprained ankle or other foot, ankle or lower leg fractures.
There are different forms of fracture of the outer ankle: demolition fracture (avulsion fracture), fatigue fracture (stress fracture), pot fracture, undisplaced, displaced, incomplete fractures, debris fractures, etc.

Bimalleolar and trimalleolar fractures

Bimalleolar fracture means that both the outer ankle (part of the fibula) and the inner ankle (part of the shin) are broken.
In a trimalleolar fracture, the outer and inner ankles are injured and additionally the shin trailing edge.
As a rule, the ankle joint is unstable in a bi- and trimalleolar fracture.
In this case, the ligaments of the ankle joint are also injured.
An ultrasound examination can be used to determine whether the outer ligaments are damaged.
Bi- and trimalleolar fractures can occur in connection with dislocation.

Accompanying injuries

  1. Lesion of the articular surface of the ankle joint
  2. Violation of syndesmosis
  3. of the lateral ankle process
  4. Base fracture of the fifth metatarsal bone


Causes of an outer ankle fracture

An outer ankle fracture often occurs as a result of an ankle sprain, especially with particularly strong force.
It can also occur during a clumsy touchdown after a jump, a fall or a direct sporting encounter.

Signs and symptoms of an outer ankle fracture

The affected person feels a sharp pain on the outer ankle at the moment of injury.
The patient limps because he is unable to put weight on the injured leg.
The symptoms are greatest at night and in the morning when getting up.
The fracture of the outer ankle leads to swelling, bruising and pain when touching the affected area.
The pain may increase with certain movements of the ankle.


The diagnosis of an external ankle fracture requires a thorough subjective and objective medical examination.

An X-ray confirms the diagnosis and shows the extent of the injury.
Magnetic resonance imaging, CT and bone scintigraphy can be used to support the examination of soft tissue and to detect fatigue fractures (stress fractures) that are not visible on the X-ray image at the initial stage.

Therapy of outer ankle fracture

Conservative treatment of an isolated outer ankle fracture
If the ankle is stable, surgery can be dispensed with if the fracture is not or only slightly displaced.
The form of treatment depends on where the bone is broken.
There are several ways to protect the bone during healing.
Some doctors recommend an orthosis, others a lower leg cast; As far as the load on the leg is concerned, some orthopedists recommend loading the broken leg immediately, others prescribe a rest of 6 weeks.
In magnetic therapy, magnetic fields are attached to the ankle, which accelerates the formation of the bone callus and reduces healing times.

This method of treatment can also be started with plaster, in case of an unconsolidated fracture it is decisive.
The X-ray must be repeated at a later time to ensure that the fragments have not shifted during healing.
According to the prognosis, after about 40-50 days, the patient can walk without forearm crutches; it takes 3 months until the sporting activity can be gradually resumed.

In order to be able to load the foot, the bones do not have to be completely fused together.
Possible consequences include mild or severe stiffness as well as complaints that are particularly noticeable when the weather changes.
In children, the healing times are much shorter than in adults.

Conservative treatment of imalleolar and trimalleolar fractures

These injuries actually lead to an instability of the ankle joint and are treated surgically.
Conservative treatment is only an option if there are serious health problems and the risk of surgery could be too great or the patient cannot walk.
As an immediate measure, the ankle is usually immobilized by a splint until the swelling has subsided. After that, a lower leg cast is applied, which extends from the foot to below the knee.

If the swelling subsides, the cast can be changed frequently.
It is important to visit the doctor regularly so that new X-rays of the ankle can be taken and the stability of the ankle can be checked.
In most cases, loading the leg is not allowed in the first 6 weeks. After that, the healing of the ankle can be accompanied by a removable support bandage.

Surgical treatment – When does surgery have to be performed?

Surgical treatment of an isolated outer ankle fracture

If the fracture is displaced or the ankle joint is unstable, the injury is treated surgically.
The fracture is set up, i.e. the fragments are brought back into their exact, anatomically appropriate position (reposition).

The bone fragments are held together with special screws and metal plates attached to the bone surface while the bone callus forms.
As a rule, metal plates and screws are removed after one year during a simple surgical procedure.

Surgical treatment of bimaleolar and trimalleolar fractures

This type of fracture leads to instability of the ankle joint and makes surgical intervention necessary.
Inner and outer ankle fractures are treated with the same surgical methods as fibula fractures (see corresponding article).

Postoperative rehabilitation of the outer ankle fracture

Physitotherapy basically plays an important role, regardless of whether it is a displaced or undisplaced fracture.
With their help, strength, range of motion and balance can be regained.
The rehabilitation exercises are similar to those performed on a sprained ankle and contribute significantly to shortening healing times.
At the beginning, the passive mobilization is carried out, later the movements must be actively executed.
In order to be able to walk without crutches, the pain in the ankle must be reduced and the calf muscles strengthened.
If the symptoms allow it, one should try to stand only on the broken leg.

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