Trimalleolar fracture: What you should know

old man on a wheelchair

In a trimalleolar fracture, the three malleoli bones that make up the ankle are all broken at the same time.

It is these particular sections of the tibia and fibula that comprise the ankle that are known as malleoli. The lateral malleolus, which is located at the end of the fibula, the medial malleolus, which is located on the inside of the tibia (shinbone), and the posterior malleolus, which is located at the rear of the tibia are the three malleolus bones.

Both the foot and the ankle are supported by three bones, which act as an anchor for the ligaments that provide mobility, control, and stability.

Because a trimalleolar fracture contains fractures in three bones, surgeons believe it to be more unstable than other fractures, and it may result in subsequent ligament damage or dislocation as a result of this.

Trimalleolar fracture are discussed in this article, as well as the treatment options available, the length of time it takes to heal, and the causes and symptoms of a trimalleolar fracture.

Surgical treatment

old man on a wheelchair
After a trimalleolar fracture, a person frequently needs extensive surgery.

The fact that trimalleolar fractures are frequently unstable means that doctors will almost always advocate surgical therapy.

During the surgery, each fracture will require a unique repair process to be performed.

Lateral malleolus fracture

In the first instance, the surgeon will realign the bone pieces, putting them back in their original positions.

Afterwards, the surgeon will affix screws and metal plates to the outside surfaces of the bones in order to keep them in place.

It may be necessary for the surgeon to put a screw or rod into a patient’s bone in order to hold the bone pieces together while they mend.

Medial malleolus fracture

Surgery on the medial malleoli can increase the likelihood of a successful recovery and allow a person to return to normal movement sooner after a severe trauma.

An impaction of the ankle joint may occur as a result of a medial malleolus fracture, which occurs when one bone is forced into another by an external force. When this occurs, a surgeon may be required to perform a bone transplant, which serves as a framework for the growth of new bone. Arthritis can be reduced with the use of bone grafting.

Surgeons can repair bone fragments with screws, plates, and wiring procedures.

Posterior malleolus fracture

There are a variety of surgical procedures available for this malleolus. A procedure that involves the insertion of screws running from the front to the rear of the ankle, or the other way around, is one alternative.

The other option involves fitting plates and screws along the back of the tibia.

Nonsurgical treatment

While clinicians frequently prescribe surgery following a trimalleolar fracture, surgical intervention may not be suitable for all patients with this kind of fracture.

Nonsurgical therapy is frequently used for people with major health problems for whom the danger of surgery is too great, as well as for those who are unable to walk due to their condition.

The use of a splint to brace the ankle until the swelling subsides is typically the first line of therapy for this condition. When the swelling has decreased enough, the doctor may apply a short cast, which they will replace with smaller casts as the swelling continues to decrease.

The individual will require frequent X-rays to verify that the ankle remains stable over time.

It is possible that a person will be unable to put any weight on their ankle for up to 6 weeks. Once the ankle has healed, they may be able to wear a detachable brace to keep it from being immobilized any longer.


If someone has undergone ankle surgery, they will be unable to bear weight on the ankle for a period of time.

The length of time required will be determined by a number of factors, including the stability of the bones and the severity of the injury to the surrounding joint structures.

A person will frequently suffer significant swelling around the injured area. The following are some of the ways that swelling might interfere with recovery:

  • prolong the healing process.
  • delay further surgery
  • cause blisters on the skin
  • increase the chance of infection

A regular physical therapy regimen will be necessary for a complete recovery.

Causes and symptoms

A trimalleolar fracture of the ankle is most commonly caused by a high-impact injury, such as one sustained while participating in sports or in a vehicle accident. A simple trip or fall, on the other hand, might result in an injury.

An ankle fracture might appear to be the same as a severe sprain in many cases, however the following are the most typical signs and symptoms of an ankle fracture:

  • swelling
  • bruising
  • an inability to put weight on the damaged ankle
  • immediate and severe pain
  • tenderness to the touch

In addition, the ankle may look to be out of position or to have a deformity to it.


An ankle injury need the immediate attention of a medical professional. In addition to reviewing the patient’s medical history and symptoms, the doctor will also discuss the circumstances that led up to the accident before doing a physical examination.

The doctor will do more tests to determine whether or not there is a fracture. Among the tests are:

  • X-ray: This is the most common way to diagnose a fracture. An X-ray can show any breaks or displacement in a bone. It can also identify how many pieces of broken bone there are in the area of the break.
  • Stress test: This is a special X-ray that is used to determine whether or not surgery is required.
  • A CT scan: This can assist a doctor in determining the extent of the damage. It is particularly beneficial if the fracture has spread to the ankle joint.
  • An MRI scan: A high-resolution picture of the anklebones and soft tissue is obtained during this procedure. It can also assist a doctor in determining whether or not there has been any ligament injury.

Here, learn more about MRI scans.


It is possible that ankle fractures will result in complications. One complication is malunion, which occurs when the bones move during the healing process and remain out of place after the healing process is complete.

Malunion is most commonly seen after nonsurgical therapy has been completed. It has the potential to make the ankle unstable and potentially cause arthritis in the long run.

Other issues to consider are as follows:

  • infection
  • bleeding
  • pain
  • blood clots in the leg
  • damage to blood vessels, tendons, or nerves
  • problems with bone healing, such as non-union, in which the bones do not connect after recovery
  • arthritis

Similar injuries

The three malleolus bones may all be fractured independently of one another without impacting the other members of the group.

A bimalleolar fracture, which occurs when two of the three malleoli are broken, may also occur in the body. The majority of persons who suffer from bimalleolar fractures shatter both the lateral and medial malleoli.

A bimalleolar comparable fracture has also been reported in certain individuals. This happens when one of the malleoli, as well as the ligaments on the inside of the ankle, are damaged. In many bimalleolar counterparts, the fibula fractures, causing damage to the medial ligaments and other structures.

Both bimalleolar fractures and bimalleolar equivalent fractures are often treated surgically since they may render the ankle unstable and lead to a dislocation if left untreated.


A trimalleolar fracture is a major injury that will significantly impair a person’s mobility and quality of life for the duration of the healing process.

It is critical that patients participate in their own recovery by participating in physical therapy and doing home exercises to strengthen the ankle joint. Even after a fracture has healed, it might take months for the muscles to acquire enough strength to allow a person to walk appropriately once again.

Following an ankle fracture, a person may recover full mobility with the help of comprehensive therapy. According to the American Academy of Orthopaedic Surgeons, however, it might take up to two years to complete the procedure.