Ankle Fractures

The ankle joint is formed by three bones — the tibia, fibula, and talus — held together by a complex of ligaments. An ankle fracture involves a break in one or more of these bones, most commonly the fibula, the tibia, or both. The severity ranges from an isolated stable fracture of the fibula tip that can be managed in a walking boot, to bimalleolar or trimalleolar fractures involving multiple bones that require surgical stabilization to restore joint congruency and allow proper healing.

One of the most important clinical points about ankle fractures is how closely they can resemble severe ankle sprains in the acute setting. Both produce immediate pain, swelling, bruising, and difficulty bearing weight. The distinction between a fracture and a sprain cannot be reliably made by clinical examination alone — imaging is required. Many patients who have been told they have 'just a bad sprain' by an urgent care provider are later found to have fractures when properly evaluated. The consequences of managing a fracture as a sprain — continued loading without appropriate immobilization — can be significant.

Ankle fractures are classified by the bones involved, the stability of the fracture pattern, and the integrity of the syndesmotic ligament complex that holds the tibia and fibula in proper relationship at the ankle joint. Stable fractures — where the joint remains properly aligned and the syndesmosis is intact — can often be managed non-surgically with immobilization and protected weight bearing. Unstable fractures — where the joint is mal-aligned or the syndesmosis is disrupted — typically require surgical fixation to restore the precise anatomical relationships the ankle joint requires for normal function.

Dr. Gunter evaluates ankle injuries with weight-bearing or stress X-rays when appropriate, assesses the stability of the fracture pattern, and determines the most appropriate management approach. For fractures requiring surgical fixation, he performs ankle fracture surgery at CHRISTUS Santa Rosa Alamo Heights and affiliated facilities, as well as Northeast Baptist, Westover Hills Baptist, and Methodist Metropolitan.