Bimalleolar and Trimalleolar Ankle Fractures

Bimalleolar and Trimalleolar Ankle Fractures

The ankle joint is where the bones of the leg (the tibia and fibula) meet with the bones on the hindfoot (talus) to form a joint that allows the foot to bend up and down. The ankle joint is susceptible to injury and one common typeof injury is called an ankle fracture. Ankle fractures can occur from many types of trauma including slips on the ice, a fall down stairs, sports injuries, and car crashes.

Read more about : Leg lengthening surgery success story in Iran

Read more about : Total knee replacement surgery success story in Iran

There are different types of ankle fractures that can occur, and one of the more serious types is called a bimalleolar ankle fracture--an injury to both the inner and outer side of the ankle. Bimalleolar ankle fractures almost always require surgical treatment. Only in rare circumstances, usually because of poor patient health or limited function, would a bimalleolar ankle fracture be treated without surgery.


An ankle fracture can be caused in many ways, and because of that, each individual injury is slightly different and the treatment and recovery may very significantly from one injury to another. Some people are confused when they have an ankle fracture that requires surgery and prolonged therapy when someone else they know just wore a brace for a few weeks. While both of these injuries were ankle fractures, they were clearly very different and had different timelines for recovery.

Most bimalleolar and trimalleolar ankle fractures are serious injuries. They often occur from high energy injuries such as falls and motor vehicle collisions. In addition to the force of impact, there is often a significant force of rotation on the ankle seen in sports injuries and serious falls. Sometimes these fractures can occur due to a weakening of the bone, most commonly in people with osteoporosis. That's not to say that people who have these injuries have weak bone--sometimes the force of injury is just too much for even the strongest bone. However, in people with underlying conditions that weaken the bone, these injuries can occur with less force than in other people.

When a bimalleolar ankle fracture occurs, there is an injury to both the medial malleolus (inner side of the ankle) and the lateral malleolus (outer side of the ankle). Because both sides are injured, the ankle joint becomes unstable. An unstable injury occurs when the fracture disrupts the structural integrity of the ankle (joint). Because the joint is unstable, it is susceptible to damage and early ankle arthritis if left untreated. Therefore, the typical treatment is to surgically repair the fracture to stabilize the ankle joint.

One special subset of these fractures is called a bimalleolar equivalent fracture. This typically occurs when there is a fracture of the lateral malleolus and a ligament injury on the inner side of the ankle (the deltoid ligament). While this particular injury does not involve a bone injury on the inner side of the ankle, the ligament injury that has occurred causes the ankle joint to become unstable and requires surgical treatment to stabilize the joint.


Trimalleolar Ankle Fractures

Another variant of this type of injury is called a trimalleolar ankle fracture. The typical bimalleolar fracture involves bone injury to the inner and outer side of the ankle. People who sustain a trimalleolar ankle fracture also have a bone injury at the back of the tibia (posterior malleolus fracture) near the ankle joint. Often this does not change the treatment from that of a bimalleolar ankle fracture. However, if the bone injury in the back of the tibia, called the posterior malleolus, causes instability of the ankle joint, it may need to also be repaired at the time of surgery.


Treatment of Complex Ankle Fractures

Treatment of all of these injuries is similar, and almost always requires surgery. The surgical procedure is performed to repair the bones, most often with metal plates and screws.  These implants repair the bones to restore the stability of the ankle joint. It is very important to repair the bones with proper alignment; if not lined up perfectly there is a higher chance of developing early ankle arthritis.

One of the concerns of these complex ankle fractures is that they are usually accompanied by significant ankle swelling. Often this swelling can be serious, and may even cause blisters (called fracture blisters) to form on the skin. Surgery is frequently delayed days or weeks if there is significant swelling. Severe swelling not only makes the surgery more difficult to perform but can dramatically increase the risk of infection and healing problems after surgery.
As mentioned, infection and wound complications are the most worrisome concerns associated with ankle fracture surgery. Other common complications include stiffness and long-term swelling. Many patients notice swelling after ankle fracture surgery for six months, and may always have some increased swelling. Another concern is that because the bone is directly under the skin, metal plates and screws are sometimes bothersome and require removal. Lastly, even with appropriate care, surgical repair, and proper rehabilitation, ankle arthritis can occur.

10 common question about bimalleolar and trimalleolar ankle fractures

1What is a Trimalleolar fracture of the ankle?
A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. The trauma is sometimes accompanied by ligament damage and dislocation.
2How long does it take for a Bimalleolar fracture to heal after surgery?
Recovery and aftercare. It takes about six weeks for a bone to heal after a fracture. If you also had damaged tendons or ligaments, then those may take longer to heal. However, no two people will recover at the same speed because there are so many variables that affect recovery.
3What causes a Trimalleolar fracture?
A trimalleolar fracture of the ankle often results from a high-impact injury, such as from a sport or car accident. However, a simple trip or fall can also cause the injury. A severe sprain can often feel the same as a break, but the following are common symptoms for a fractured ankle: immediate and severe pain.
4What is a Bimalleolar fracture?
A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities.
5How serious is a Bimalleolar fracture?
Bimalleolar fractures can cause severe pain, swelling, and bruising in the injured ankle. They also can be tender to the touch and make walking or putting any weight on the affected foot very difficult and painful.
6Can you walk on a broken ankle with a boot?
In most cases, you will not be allowed to bear weight on your injured ankle at first. At some point, you will use a special walking boot as the healing progresses.
7How long does it take to walk again after ankle surgery?
Recovery. Each injury is different and every body heals at its own pace, but it will take at least six weeks for your bones to heal. If you've also torn ligaments or tendons, the healing time will be longer. After surgery, you won't be able to move your leg to allow yourself to heal and avoid the risk of re-injury.
8Can you walk on a broken ankle after 4 weeks?
You will not be allowed to put weight on the broken ankle so crutches are needed to walk with. ... After four weeks you may be able to put some weight on the ankle or change the plaster for a special removable boot. You will be seen regularly at the fracture clinic and have further X-rays to monitor the healing.
9Can you fully recover from a broken ankle?
Broken Ankle Recovery Time. The recovery time for a broken ankle can range from 6 weeks to 12 weeks and longer depending on the severity. After your break or fracture has been fully diagnosed, you will receive a treatment plan. Your ankle injury treatment plan will depend on the type and severity of your injury.
10What is a Trimalleolar equivalent fracture?
Trimalleolar fractures means that all three malleoli of the ankle are broken. These are unstable injuries and they can be associated with a dislocation.


Leave a Reply

Your email address will not be published. Required fields are marked *

Patient Review