Nursing Guide to Ankle Fractures: Nursing Diagnosis, Interventions, & Care Plans

Ankle Fracture Etiology and epidemiology 

Ankle fractures occur when one or more of the bones in the ankle joint — such as the tibia, fibula, or talus — break due to severe force or extreme flexion/extension. These fractures represent about 15% of all ankle injuries treated in emergency departments. There is a bimodal distribution of these injuries, with higher incidence in younger males due to sports or high-impact activities and in older females, particularly postmenopausal women, due to osteoporotic changes (Kadakia et al., 2017; Mandell et al., 2017). 

Types of ankle fractures (Danis-Weber classification) 

1. Type A: Stable horizontal fracture below the ankle joint. 
2. Type B: Spiral fracture at the level of the ankle joint, which may be stable or unstable depending on ligament involvement or associated fractures. 
3. Type C: Unstable fracture above the ankle joint, often requiring open reduction and internal fixation (ORIF) due to ligament disruption. 

Complications 

• Delayed union: Slowed healing process. 
• Non-union: Failure of the fracture to heal after eight weeks. 
• Infection: Particularly in open fractures. 
• Acute compartment syndrome: A medical emergency that requires urgent intervention to prevent lasting damage to the muscles and nerves (Barile et al., 2017; Strudwick et al., 2018). 

Ankle Fracture Diagnosis 

Diagnostic tools for ankle fractures include: 

• X-rays: Standard imaging to identify and classify the fracture. 
• Ultrasound: Useful for assessing ligament, tendon injuries, and identifying fractures when X-rays are inconclusive (Barile et al., 2017). 
• CT scan or MRI: For complex fractures or when additional soft tissue damage is suspected. 
• Lab tests: 
• CBC and blood type: If there is significant blood loss. 
• Pre-operative labs: Including coagulation profile, if surgery is indicated. 

Management 

Immediate care 

• Initial assessment: Includes X-ray interpretation to determine the fracture type and extent. 
• Pain management: Administer prescribed analgesics or NSAIDs. 
• Immobilization: Initial splinting to stabilize the fracture. 
• Procedural sedation: May be needed for closed reduction or to alleviate pain during immobilization. 
• Referral: To an orthopedic physician for further evaluation and management. 

Surgical Intervention 

• ORIF: Often required for complex fractures with significant displacement. 
• Thromboprophylaxis: Essential to prevent deep vein thrombosis (DVT) and pulmonary embolism before full mobilization. 

Post-surgical care 

• Bed rest and immobilization: Necessary post-ORIF. 
• NPO status: Before surgical intervention. 
• Diet: Increased protein and calcium to support bone healing. 
• Antibiotics: Used pre- and post-operatively for open fractures to prevent infection. 

Ankle Fracture Nursing Care Plan

Nursing considerations 

Assessment 

Assess for the following: 

• Injury details: Time of injury, mechanism (e.g., rolling, twisting), and associated symptoms (e.g., popping, cracking noise). 
• Pain and mobility: Specific location of pain, ability to move the ankle, and presence of deformity. 
• Physical exam: Look for bruising, swelling, abrasions, joint stability, and evidence of Achilles tendon involvement. 
• Neurovascular status: Assess pulses, sensation, and check for signs of compartment syndrome (5 P’s: pulselessness, pallor, paresthesia, pain, paralysis). 

Ankle Fracture Nursing diagnoses 

• Alteration in comfort 
• Impaired tissue perfusion 
• Self-care deficit 
• Risk for injury (e.g., walking with crutches) 
• Knowledge deficit 
• Anxiety 
• Acute pain 
• Impaired skin integrity 
• Risk for infection 
• Impaired physical mobility 
• Constipation (from narcotics use) 

Interventions 

• Cold application: Apply ice packs to reduce swelling. 
• Elevation: Elevate the affected limb to decrease swelling. 
• Pain management: Administer prescribed analgesics and monitor for effectiveness. 
• Education: Provide instructions on cast care, use of crutches or walking boots, and signs of complications that require returning to the hospital. 
• Monitor for complications: Regularly assess neurovascular status, look for signs of compartment syndrome, and maintain aseptic technique during wound care. 

Expected outcomes 

• Pain relief: Effective management of pain. 
• Safe recovery: Resumption of normal activities once healing is complete. 
• Understanding of care: Patient understands limitations during healing and how to care for the cast or splint. 
• No complications: Patient remains free of complications such as infection or compartment syndrome. 

Individual/caregiver education 

• Cast/splint care: Instructions on how to care for the cast or splint to prevent damage and skin complications. 
• Crutch walking: Proper technique to avoid falls and further injury. 
• Signs of compartment syndrome: Teach the 5 P’s and the importance of immediate medical attention if they occur. 
• Pain medication: Take as directed and be aware of potential side effects. 
• Follow-up care: Importance of attending follow-up appointments with an orthopedic physician and physical therapist. 
• Activity limitations: Avoid activities that put stress on the healing ankle and follow recommendations from PT. 
• Preventing future injuries: Use proper footwear and avoid high-impact activities until fully recovered. Osteoporosis treatment as appropriate. 

ICD-10 code for ankle fractures 

• S82.8XXA — Other fractures of lower leg, initial encounter 

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

References 

• Barile, A., et al. (2017). Emergency and Trauma of the Ankle. Seminars in Musculoskeletal Radiology, 21(3), 282-289. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0037-1602408 
• Campagne, D. (2021). Ankle fractures. Merck Manual Professional Version. https://www.merckmanuals.com/professional/injuries-poisoning/fractures/ankle-fractures 
• Kadakia, R. J., et al. (2017). Ankle fractures in the elderly: Risks and management challenges. Orthopedic Research and Reviews, 9, 45. https://www.dovepress.com/ankle-fractures-in-the-elderly-risks-and-management-challenges-peer-reviewed-fulltext-article-ORR 
• Mandell, J. C., Khurana, B., & Smith, S. E. (2017). Stress fractures of the foot and ankle, part 2: Site-specific etiology, imaging, and treatment. Skeletal Radiology, 46(9), 1165-1186. https://link.springer.com/article/10.1007/s00256-017-2632-7 
• Strudwick, K., et al. (2018). Best practice management of common ankle and foot injuries in the emergency department. Emergency Medicine Australasia, 30(2), 152-180. https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.12904 
• Taylor, B. & Tarazona, D. (Updated 2024). Ankle fractures. Orthobullets. Retrieved from https://www.orthobullets.com/trauma/1047/ankle-fractures