Trimalleolar fractures are the least common ankle fracture. A trimalleolar fracture happens when you break your lower leg sections that form your ankle joint and help you move your foot and ankle. Treatment includes surgery and extensive physical therapy. A trimalleolar fracture can have long-term impact on your quality of life.
Trimalleolar fractures happen when you break the lower leg sections that form your ankle joint and help you move your foot and ankle. Trimalleolar fractures require surgery and extensive physical therapy. A trimalleolar fracture can have a long-term impact on your quality of life.
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When you have a trimalleolar fracture, you've broken three bony sections at the end of your lower leg bones:
The bony sections, which are sometimes called the malleo complex, create a three-sided frame supporting the ligaments that keep your ankle stable and let you move your ankle and foot.
A trimalleolar fracture is a serious injury that can affect your quality of life and cause long term problems:
Trimalleolar fractures can have several causes:
Historically, adults ages 65 and older are most commonly treated for trimalleolar fractures after tripping and falling. Younger people are injured playing sports, being in motor vehicle accidents or falling.
As older adults remain active longer, healthcare providers are treating more trimalleolar fractures from sports injuries, motor vehicle accidents and falls from heights.
A bimalleolar fracture happens when you break your bony knobs that stick out from the inside and outside of your ankle. These bony knobs are your medial malleolus and your lateral malleolus.
Trimalleolar fracture symptoms include:
Trying to walk with a trimalleolar fracture would be very painful and might damage your ankle ligaments and tendons.
You’ll receive medicine for pain. Trimalleolar fractures are treated with ankle surgery and physical therapy. Most trimalleolar fractures are treated with Open Reduction Internal Fixation (ORIF) surgery. The goal of ORIF surgery is to line up your broken bones so they heal appropriately.
You'll receive general anesthesia. To prepare for general anesthesia, you should:
Surgeons typically repair your medial malleolus, your tibia's bottom section, and your lateral malleolus, your fibula's bottom section. They might repair your malleolus, the back of your tibia, depending on the size of the fracture.
Your healthcare provider will discuss your pain concerns with you and provide appropriate medication.
Physical therapy is an essential part of recovering from a trimalleolar fracture.
It could be six weeks before you can put weight on your injured ankle or walk using your injured ankle. Healing from trimalleolar surgery takes time as your broken bones heal around the tools surgeons used to stabilize your bones. Be sure to talk to your healthcare provider before putting weight on your injured ankle.
There are several things to consider before you go back to work:
It could be several months before you can drive:
Most people who played sports before their trimalleolar fracture can get back in the game. But it usually takes four to six months before their injured ankle is strong enough to do that without re-injuring their ankle.
You should plan to have help around the house for the first six weeks as you recover from your surgery:
Long-term side effects can include:
You will have regular post-surgery checkups.
You should seek immediate healthcare if you:
A note from Cleveland Clinic
Trimalleolar fractures are complicated and serious injuries. You might need more than one surgery to repair each broken bone. You might have damaged your ankle tendons and ligaments, which adds to your recovery time.
A trimalleolar fracture affects your quality of life, as you will need help with day-to-day activities until you can put weight on your ankle. (Even then, your ankle might feel wobbly or unstable because your ligaments and tendons take more time to heal than your bones.)
You might become frustrated, anxious or feel depressed as you wait for your ankle to heal. Tell your healthcare provider how you are feeling. They'll be able to recommend programs to help you manage your recovery.
Last reviewed by a Cleveland Clinic medical professional on 09/13/2021.
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