Scott Webb (Host): There are different types of ankle fractures. And depending on the type of fracture, treatment options may vary. And joining me today to tell us more about the ankle, types of fractures and treatment options is Dr. Hayden Hoffler. He's a foot and ankle surgeon with Orthopedic Associates of Central Maryland.

 Hi. I'm Scott Webb and I've got a bone to fix with you. Dr. Hoffler, thanks so much for your time today. We're going to talk about ankle fractures and what that means, what they are, and if there's different kinds and all that good stuff. So, let's just start there. What is an ankle fracture?

Dr. Hayden L. Hoffler: An ankle fracture is a broken bone or a fracture of the distal or end part of the leg. And there's two leg bones. There's the tibia and the fibula. So, it involves breaking, it can be either or bone, but it's most commonly the fibula or the lateral malleolus.

Host: Any particular reason why? Is it just because of the nature of how we use our feet and the types of things we're doing and the respective acute injuries? Is that the reason why that one is more likely to be the one that breaks? Or is it just flip of the coin? How does that work?

Dr. Hayden L. Hoffler: Sure. So, there's a lot of biomechanics involved, but it has to do with three different reasons of potentially why ankle fractures can occur. Number one being rotational, and that's the most common, and that's due to a certain foot position with the ankle twisting on it, causing an injury. And that's most likely why it's the lateral malleolus or fibula affected. The second reason can be direct impact or direct trauma, such as a car accident. And the third kind of ankle fracture topic or category can be a dislocation where the bones actually shift out of place.

Host: Yeah. All of these sound really painful. I'm sort of cringing as I'm hearing you describe these. None of it sounds good. I've never actually broken my ankle, so I don't know exactly what it feels like, so it's just purely anecdotal. But what does it feel like? Like, do you know? Is it one of those things like I've heard about like ACL tears, things like that, that people just know? They hear a pop and they grab their knee and they just know. Do folks just know that they've broken something in their ankle? And is that just the immediate sign, "Yes, head to the emergency department or head to their doctor," right?

Dr. Hayden L. Hoffler: Yeah. So, that's actually a great question. So, ankle fractures can present like multiple lower extremity injuries. Most commonly, there's pain around the area that could be inside, outside or both, or even surrounding the entire ankle. It could be due to, you know, falling, playing a sport, direct impact, et cetera. It can also present kind of like a high ankle sprain or an ankle sprain, where there's a lot of swelling, bruising around the area. A common presentation for dislocations is where the bone's actually tenting on the skin, and that's when, you know, generally, a quick workup and even surgery is indicated.

Host: Yeah, right. You use the word tenting and I can sort of picture that. So if, the bone's tenting on the skin, that's a good sign to head on in. Some of the others, it sounds like maybe a little bit of wait and see, right? Like maybe it's just a bruise or something like that. Does it become obvious at some point though, where the pain, swelling, and that kind of thing is just not going away, despite our best efforts that it's time to head in?

Dr. Hayden L. Hoffler: Yeah, exactly. And usually, it's due to not being able to put any weight on it, completely swollen. Some patients do hear a pop that can relate to the ankle fracture or a soft tissue injury that can occur with the bony injury. But most of the time, it's due to the pain, swelling, possibly deformity of the ankle, depending on what happened as well as the inability to put weight on it.

Host: Yeah, for sure. And I know that you're a foot and ankle surgeon, so let's talk about that. If we end up having a fracture, one of the respective fractures, how often is surgery indicated? Are there some other things that are tried before you get to surgery? Take us through that.

Dr. Hayden L. Hoffler: Sure. So, a lot of ankle fractures actually can be treated conservatively, and it all depends on the amount of displacement as well as patient factors, demographics. You know, are they diabetic? Do they have other medical problems? Is their skin tenting? Is it open? For more of these with minimal to no displacement, they can be treated conservatively, you know, first with a splint while they're swollen and then a cast treatment for about six weeks.

For others that are more displaced, whether that be in both the fibula or the tibia, or even torn ligaments that are contributing to it, those could warrant surgery. And then, the immediate surgery is when we talk about skin tenting, inability to reduce an ankle fracture, or ones that are continued to be dislocated, because that affects the neurovascular, supply in especially the skin. And then, the ones that are open, that's the last category where it's a surgical emergency, where they need to go to the operating room and have it reduced and potentially fixed right away.

Host: Yeah. And I just wanted to ask you about recovery. Is it sort of varied depending on what caused original injury or is there sort of a standard? "Well, if you have ankle surgery of really any type, you're going to be out this long." Roughly speaking or generally speaking, what's the recovery like?

Dr. Hayden L. Hoffler: Yeah. So generally for ankle fractures, whether treated conservatively or operatively, you're generally non-weight-bearing for about six weeks or so. Some people a little bit longer, some people a little bit less. With our diabetics, we extend the non-weight-bearing period a little bit longer to help with healing. Generally after the six weeks, you're weight-bearing as tolerated in a boot. That's more or less for protection. That's when you begin range of motion. You also work with physical therapy to work on strength. And then after that, you transition either into a lace up ankle brace or feel pretty steady back into regular shoes at that point.

Host: Yeah. You mentioned strength there. It just makes me wonder, is there anything that we can do? You know, I know we can work out different parts of our bodies and walk and run and do all sorts of things just to stay physically active and healthy. Is there anything specifically that you recommend to keep our ankles stronger, with respect to some of the things you've said here, obviously, like try to avoid car accidents and those types of traumatic injuries? But in general for us, for lifestyle behavior and overall health, is there anything we can do?

Dr. Hayden L. Hoffler: Yeah. So, that's another good question. We see a lot, especially in our elderly folks who are, you know, breaking their ankles. I usually recommend vitamin D or even calcium supplementation to help with bone strength. It's hard to avoid those sudden accidents, sports injuries, especially in the younger patients. But just general workups, if there's any , signs or symptoms of weak bones or they've had a history, getting repeat scans just to make sure they have adequate bone health as well. And if you're not able to treat it, setting them up with a bone health doctor or nurse practitioner, or even a PA, would be sufficient as well just to make sure they have adequate supplementation.

Host: Yeah. So as you say, like with some folks, especially supplementation, some things we can do, obviously these sort of traumatic, sudden injuries, be they sports or otherwise, it is what it is. And good thing we have experts that we can turn to in case we need surgery. Good stuff today. Doctor, just want to ask you, you know, final thoughts, takeaways when you think about ankle fractures in general and what folks should know. What would you most like them to know?

Dr. Hayden L. Hoffler: Yeah. I mean, big takeaways from this talk are if you have continued pain, swelling or even deformity, go seek medical treatment either from a foot and ankle specialist or orthopedist. That way, treatment can be initiated as quickly as possible and you can get back to regular activities. My thoughts and even the thoughts in the medical literature are the earlier they're treated, the better the outcomes are for these ankle fractures as well.

Host: Yeah. As you say, if you've got tenting or deformity, neither of those things are good things. Those are definitely not sort of surveillance, wait-and-see type things. So, time to head on in, get some x-rays, speak perhaps with a surgeon who can, you know, really help us and get us on the road to recovery. So, thanks so much today, and you stay well.

Dr. Hayden L. Hoffler: Great. Thanks so much. You have a good day.

Host: That's Dr. Hayden Hoffler, foot and ankle surgeon with Orthopedic Associates of Central Maryland. And meeting with an orthopedist doesn't always mean surgery. Schedule an appointment today easily online for a consultation about your pain. Go to mdbonedocs.com.

 Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb and that was a bone that's fixed.