[1] Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg.

[1] Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.

[7] Together the tibia and fibula form a bracket-shaped socket known as the mortise, into which the dome-shaped talus fits.

[8] The talus and the fibula are connected by a strong group of ligaments, which provide support for the lateral aspect of the ankle.

[9] The calcaneofibular ligament (CFL), which connects the fibula to the calcaneus, or heel bone, also provides lateral support.

The deltoid ligament provides support to the medial part of the ankle (closest to the midline).

Patients may notice ecchymosis ("black and blue" coloration from bleeding under the skin), or there may be an abnormal position, alignment, gross instability, or lack of normal motion secondary to pain.

[10] It is important to evaluate the exact location of the pain, the range of motion of the ankle, and the condition of the nerves and blood vessels.

Imaging for evaluation of ankle fractures can include x-rays, CT scans, and MRIs.

MRI is less commonly used to diagnose ankle fractures but may be used to show problems involving the soft tissues (ligaments and tendons) and articular cartilage.

Unstable fractures require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs.

[12] Stable ankle fractures with preserved joint alignment may be treated with non-operative measures (splinting, casting, and/or walking boot).

[9] If post-operative x-rays are concerning for malunion, then patients may need an additional procedure to restore proper ankle anatomy.

[9] Post-traumatic arthritis can initially be managed with conservative options like activity modification, non-steroidal anti-inflammatory medication (NSAIDs), specialized footwear, and cortisone injections.

As a result, some patients decide to have the hardware removed after the fracture has healed through an additional procedure.