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Ankle Fracture Nursing Guide

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

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 

FAQ

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

References 

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