BIMALLEOLAR AND TRIMALLEOLAR FRACTURES
Treating Bimalleolar and Trimalleolar Fractures
by ACE Physical Therapy and Sports Medicine Institute
Tips for Bi- and Trimalleolar Fractures.
- The most common group to suffer these injuries are women over the age of 60.
- Surgery is needed to “set” the bones after a bi or trimalleolar fracture occurs.
- A period of non-weight bearing that lasts 2-4 months will be required to allow the bones to heal properly.
- Bearing weight too early on the involved leg can lead to a premature onset of arthritis in the ankle/foot complex.
- Seek the advice of a Physical Therapist for the proper rehabilitation treatment program.
Fracturing any bone can be painful and take time for recovery, but fracturing an ankle is particularly challenging. While high impact sports accidents can cause ankle fractures, so can simple falls. The type and severity of fracture will determine both treatment and length of recovery. A bi or trimalleolar fracture is extremely severe and will incapacitate a person for an extended period of time. A formal physical therapy program over long period of time is vital to recovery.
The Difference Between Bimalleolar and Trimalleolar Fractures
On the distal end of the Tibia and Fibula a “lump” of bone develops into a malleolus or malleoli (singular). These bony projections are used by tendons to create a pulley effect, enabling them to generate the greater force required to move and control the ankle/foot complex. This is an area that acts as an anchoring location for the ligaments that are the static stabilizing structures of the ankle/foot complex. There are two very noticeable malleoli and a third that is not recognizable without the use of an x-ray. The Tibia has the medial and posterior malleoli and the fibula has the lateral malleoli. If two of these are involved in a fractured ankle, then it is labeled a bimalleolar fracture and if all three are involved then the diagnosis becomes a trimalleolar fracture.
Treating Bimalleolar and Trimalleolar Fractures
The treatment for a bi or trimalleolar fracture begins immediately. The ankle should be stabilized, and the person should be transported to the emergency room. Surgery is required to “fix” these fracture sites. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. Following surgery the patient will be completely non-weight bearing for a period of 2-3 months. The repaired ankle will be incapable of bearing any weight for a long period of time and doing so could shift the placement of the repaired bones. Any misalignment of the bones could predispose the patient to an early onset of osteoarthritis in the joints of the ankle/foot complex.
Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. This swelling can be serious, and may even cause blisters (called fracture blisters) to form on the skin. Surgery is frequently delayed days or weeks if there is too much swelling. Severe swelling makes the surgery more difficult to perform. It can also increase the risk of infection and delay healing after surgery.
Physical Therapy for Bimalleolar and Trimalleolar Fractures
Most surgeons wait 2-4 weeks to start a formal physical therapy routine (but it begin immediately). The initial treatment is geared towards reducing swelling and pain and restoring the passive motion of any body part that is not in a cast. The patient can perform limited core, hip and knee exercises in an attempt to prevent excessive atrophy due to the non-weight bearing status. The atrophy is almost inevitable and will be one of the main reasons that the total time for rehabilitation following this type of fracture can last longer than one year!
Normally, the patient is approved to transition to full weight bearing the end of the 3rd or 4th month. While patients are usually hesitant to put weight on the involved leg, a physical therapist can help with the transition. The therapist can educate the patient on ways to transition from non-weight bearing to full weight bearing and answer any questions about the different sensations that will occur when the foot is placed on the ground for the first time following surgery. There will be pain, tingling, numbness in ankle/foot complex and a strong feeling of instability throughout the involved leg. The therapy will include strengthening exercises for the core and entire lower extremity. It will be a very long process to restore the strength, muscular endurance and proprioception throughout musculoskeletal system because the entire body is effected when there is a prolonged period of now weight bearing.
Bi and trimalleolar fractures are devastating injuries to sustain and the involved person’s life will be dramatically effected for several months. With proper rehabilitation, the patient can restore their full function within the involved leg albeit it will take the better part of 1 year or longer.
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