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Trimalleolar fracture

Trimalleolar fracture is one among the three fractures that involve fractures of the ankle, the other two being single malleolar fracture and bimalleolar fracture. When fractures of the medial, lateral malleoli of the tibia occur in conjunction with the injury of posterior malleoli, it is called trimalleolar fracture. Ankle injuries are mostly sports-related and only 15% of those patients who are evaluated for ankle injuries show significant symptoms of a fracture. Hence for proper management of ankle injuries, familiarity with a thorough ligamentous examination and the Ottawa ankle rules are very important.

The primary care physician should be able to differentiate between a stable injury and an unstable injury. A ring is formed around the ankle mortise by the bones and ligaments. Diagnosis and treatment for trimalleolar fracture need careful examination of the patient. Some important facts like whether the injury was due to inversion or eversion or due to internal or external rotation of the foot should be gathered by questioning the patient. If the patient is able to recall these details, it will be useful to assess patient's stability. Yet another important information the patient can provide is whether he or she could bear weight after injury, since it is specified in the Ottawa ankle rules that inability to bear weight after the injury indicates the need for radiographic examination. Casting or surgical correction are the two options of treatment available for patients who suffer trimalleolar fracture.

Ankle Injury

Injuries of the ankle while indulging in sports or some other activity can be termed as ankle injury. The most common ankle injury is an ankle sprain and occurs due to an injury i.e. either a tear, twist or overstretch of the ligaments. The most often sprained joint is the ankle joint. A stretch of the ligament causes a minor sprain and a severe sprain is a result of tearing of the ligament itself. Common causes for an ankle sprain:


  • Ankle sprain occurs when the foot or heel twists inwards when compared to the lower leg thereby causing a stretch for the ligaments outside the ankle. This is termed as inversion sprain. If the foot or heel twists outwards, which is uncommon that condition is referred to as eversion sprain.
  • People who have weak muscles in the lower leg
  • People who have loose ligament in the ankle
  • People who have sprained their ankle earlier and did not let it heal completely have chances of spraining the same ankle yet again.
  • Sprains are common while climbing the stairs or while walking on uneven surfaces.
  • People who wear high heeled shoes or slippers have more chances to sprain if they slip off their footwear while walking.
  • While running, jumping, during a game of football or tennis, ankle injuries are common.

Symptoms of ankle sprain include severe pain at the site of the injury and inflammation and possible bruising. There is trouble in moving the joint. Other than cases of severe ankle sprains where professional help is required, an ankle sprain can be treated by self care. The most common method followed for ankle sprain is RICE:


  • R: Rest. Rest the injury by limiting moving around and keeping weight off the affected place at least for 24-48 hours from when the injury has occurred.
  • I: Ice. Place ice in a bag and apply on the affected area, this will bring down the inflammation, pain and bruising of the area. Apply ice once in two hours for twenty minutes.
  • C: Compression. Compress the joint by applying a bandage; take care to apply the bandage firmly and not tightly.
  • E: Elevation. Put up the injured leg right above the level of the heart, this brings a lot of relief, particularly during the nights.

Medications prescribed by the doctor would include non-steroidal anti-inflammatory drugs such as ibuprofen. The physician will ask for a x-ray and according to the extent of the injury advice for physical therapy and recommend support for the ankle through taping or bracing of the ankle. Very severe damage to the ligament might call for a surgery to repair the same.


Prevention from ankle injury

  • Wear right fitting shoes or slippers.
  • Warm up before getting into vigorous sports activities.
  • Eat a healthy diet to keep your muscles and bones strong.
  • Maintain a healthy weight and balance your weight appropriately while you walk, run or jump.
  • Watch out while you walk on uneven surfaces and slippery surfaces.
  • Wear the right shoes and use the right sports equipment while you practice a sport.

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Collection of Pages - Last revised Date: November 12, 2019