Trimalleolar Fracture: Causes, Signs, Symptoms, Treatment-Conservative, Surgical
What is a Trimalleolar Fracture?
The ankle and its bones is one of the areas of our body, which is more susceptible to fracture due to its weight bearing nature and the risk of sudden twists and turns to the ankle. There are different types of ankle fracture and one of which is the Trimalleolar Fracture. Bimalleolar fracture is a more common type of ankle fracture and tibial plafond fracture is also another type of ankle fracture.
There are three malleolus in the ankle, namely the medial, lateral and the posterior malleoli. Trimalleolar fracture occurs when the three malleoli smash into each other, which results in a break or a crack in them. The two malleoli, the medial malleolus and the lateral malleolus, when crash against each other and also involve the posterior process of the tibial region i.e. the posterior malleolus, then this is known as ankle trimalleolar fracture. This term trimalleolar fracture is broadly used to include the three structures, which get affected in the trauma or impact, which causes ankle fracture.
Treatment of trimalleolar fracture comprises of often surgery to fix the broken bones together and hold them in place together as the healing takes place.
Difference between Trimalleolar Fracture & Bimalleolar Fracture
The medial malleolus is formed from the lower end of the tibia on the inside of the ankle. Fibula is a thinner bone which is present on the outside of the lower leg, which forms a bump at the end, which is known as the lateral malleolus. The third malleolus or the posterior malleolus is formed by the edge of the bone posterior to the lower end of the tibia. When there is a break or fracture of the ankle involving all the three malleoli, then this results in trimalleolar fracture. Whereas the bimalleolar fracture involves only the medial and lateral malleoli, instead of all the three structures, as is the case with Trimalleolar Fracture. This is the important differentiating factor in distinguishing between the trimalleolar and bimalleolar fracture. Trimalleolar Fracture is also thought to be a stress fracture than a burst fracture. Stress fracture occurs as result of excessive pressure or weight on the ankle causing ankle trimalleolar fracture.
Causes of Trimalleolar Fracture
- Twisting is one of the most common causes of trimalleolar fracture. Twisting of the ankle causes irregular and abnormal movements of the ankle causing it to fracture.
- Rolling of the ankle is the second most common cause for trimalleolar fracture. A sudden change in the ankle movement or placing the foot down in an inappropriate manner can cause the ankle to roll inwards and result in a trimalleolar fracture.
- Tripping or falling down by missing a step puts a lot of weight or pressure of the body on the ankle causing a trimalleolar fracture.
- Sudden forceful impact on the ankle, such as seen in automobile accidents can cause trimalleolar fracture.
- Weakening of the ankle ligaments where it cannot support the complete weight of the body can cause Trimalleolar Fracture. Weakened ligaments are seen in older individuals and causes great difficulty in the functioning of the ankle resulting in trimalleolar fracture. Older individuals having medical conditions, such as osteoporosis and some forms of cancer are at a higher risk for having Trimalleolar Fractures.
Signs & Symptoms of Trimalleolar Fracture
Given below are the symptoms of Trimalleolar Fracture. These symptoms can also be seen in other types of fracture. So, immediate medical attention should be sought whenever anyone experiences the symptoms described below. Getting prompt treatment helps in preventing worsening of trimalleolar fracture and also helps in avoiding any complications occurring from it. Given below are some of the signs and symptoms of a Trimalleolar Fracture.
- Symptoms of sudden pain is felt at the site of the trimalleolar fracture.
- Sign of swelling is seen at the site of the trimalleolar fracture.
- Bruising may also be present at the fracture site.
- Patient is not able to move the fractured trimalleolar ankle.
- Patient is not able to bear his/her weight on the affected ankle.
- The area of the fracture becomes insensitive to touch. This can indicate nerve involvement.
- In case of severe trimalleolar fracture, there is deformity or crookedness of the ankle.
Diagnosis of Trimalleolar Fracture
It is important to diagnose Trimalleolar Fracture as soon as possible. After the diagnosis and depending on the severity of the Trimalleolar Fracture, the best course of treatment is decided by the doctor. Treatment should be started immediately to prevent future complications arising from this condition. The longer the treatment is delayed, the longer it will take the patient to recover from the trimalleolar fracture.
X-rays need to be taken of the ankle to confirm if it is indeed a trimalleolar fracture. CT scan helps in giving clearer picture of the trimalleolar fracture and the surrounding structures.
Treatment for Trimalleolar Fracture
First aid should be initiated as soon as a fracture is suspected, which includes use of immobilizing devices, so that the fractured trimalleolar bones stay in place and do not move before a medical practitioner has had a look at it.
There are two treatment options for a trimalleolar fracture, which comprise of nonsurgical and surgical treatment.
Nonsurgical or Conservative Treatment for Trimalleolar Fracture
- The nonsurgical treatment for trimalleolar fracture is done only if there is no dislocation.
- The patient is told to rest and avoid weight bearing on the ankle.
- Medicines, which include pain killers and anti-inflammatories, such as acetaminophen and naproxen, help in relieving pain and swelling associated with trimalleolar fracture.
- Ankle brace is also used to keep the trimalleolar fracture stable and allow healing.
- Icing the affected region also helps in bringing down the pain and swelling associated with trimalleolar fracture.
- The recovery time for trimalleolar fracture with conservative treatment takes about six weeks.
Surgical Treatment for Trimalleolar Fracture
- Surgery is needed in severe cases of a trimalleolar fracture, especially if there is also dislocation of the trimalleolar fracture or if the bones are broken completely and they cannot heal on their own with rest and medicines alone.
- Surgery for trimalleolar fracture comprises of placement of metal plates, rods, wires and screws in the ankle, which will temporarily replace and hold the broken parts together, so that they realign and heal in a proper manner.
- After the surgery, a cast will need to be placed so that there is continued alignment of the fractured bones.
- Patient should not bear weight on the ankle until the trimalleolar fracture has healed and the fractured bones have fused together.
- The recovery time following surgical treatment for trimalleolar fracture can take up to 3 to 4 months.
- X-rays of the patient's ankle are taken during the recovery period in order to check if the bones still remain in alignment.
- Physical therapy needs to be started after the healing of the trimalleolar fracture. It helps in recovering the strength and flexibility along with other normal functions of the ankle. Physical therapy also helps in strengthening the muscles around the fractured area along with boosting the healing process of the trimalleolar fracture.