A trimalleolar fracture is a type of ankle fracture. It happens when you fracture three different areas in your ankle called the malleoli. It usually requires surgery to stabilize the ankle.

The malleoli bones, called the medial, lateral, and posterior malleoli, stick out somewhat at your ankle. They’re at the end of your tibia along the inner aspect, at the fibula along the outer aspect, and at the back of the tibia. They create a triangle in your ankle.

A trimalleolar facture can result from a number of injuries, such as a fall, car accident, or sports injury. This type of fracture may also include ligament damage and dislocation.

Some of the symptoms for a trimalleolar fracture are similar to other ankle fracture symptoms. They may include:

  • severe pain
  • tenderness in the area
  • inability to walk
  • difficulty or inability to put weight on the ankle
  • bruising
  • deformity of the ankle
  • swelling that is often severe

A trimalleolar fracture is an unstable type of ankle fracture. Surgery is usually the recommended treatment. Nonsurgical treatment would be recommended only if surgery would pose too high of a risk to you due to other health conditions.

Your doctor may recommend an over-the-counter or prescription pain medication as part of your treatment plan.

Surgery procedures

The goal of surgery is to stabilize your ankle and help speed the healing process. The exact procedure your doctor uses depends on the severity of your injury.

The surgical procedure may include some of the following options to stabilize your ankle:

  • realigning the bones
  • inserting pins or screws
  • inserting a plate and screws
  • wiring the bones together

The surgeon may also need to perform a bone graft. This can help you regrow bones that have shattered into too many pieces to pin or wire back together. Bone grafting may also help reduce the chance of developing arthritis later.

After surgery, your doctor will put you in a cast, splint, or brace, depending on your situation. The cast is usually a half-leg cast, which means it stops at your knee. However, the type of cast or brace depends on the extent of the surgical procedure and the severity of your injury.

If treatment was delayed and a deformity is apparent, then an additional surgery at a later time may be necessary to correct any deformity that remains.

It takes about six weeks for a bone to heal after a fracture. If you also had damaged tendons or ligaments, then those may take longer to heal.

However, no two people will recover at the same speed because there are so many variables that affect recovery. Your recovery time can be affected by other health conditions, the severity of your injury, the extent of your surgery, and whether you smoke.

Recovery timeline after surgery

  • 6 weeks: Your doctor will remove the cast.
  • 9 to 12 weeks: You can return to driving.
  • 2 to 4 months: Some limping is normal.
  • 3 to 4 months: You can typically return to normal activities, excluding sports.
  • 4 to 6 months: You can typically return to sports activities.

It’s not uncommon for some people to take up to 2 years to reach a complete recovery and return all normal activities without a limp.

Aftercare tips

Tips for aftercare during recovery include:

Take your pain medications. You can take over-the-counter or prescription pain medications provided by your doctor. Be aware that many prescription pain medications can cause dependency. Be sure to only take the medication as prescribed by your doctor, and be sure to discuss any concerns you have about your medication.

Avoid putting weight on your ankle. You should not put any weight on your ankle until your doctor approves it, even when you’re in a cast or brace. If you put weight on your ankle too soon, you can slow the healing process and increase your pain. It may also require you to have additional surgery.

Go to physical therapy. Depending on your injury, your doctor may prescribe some physical therapy to help you regain full mobility and use of your injured ankle.

Talk to your doctor about removal of pins and screws. Your doctor may remove your pins or screws once your ankle is fully recovered, especially if they cause you discomfort.

Use an ankle brace. Once your injury has fully healed, your doctor may still recommend that you wear a light ankle brace when you’re most active, usually during sports activities. The brace is usually only a temporary precaution for a few months.

Surgery for a trimalleolar fracture comes with possible complications just like any surgery. These complications may include:

  • blood clots in the legs
  • bleeding
  • nerve or tendon damage
  • damage to blood vessels
  • infection

In addition to these general surgery complications, you may have complications related to this specific type of injury.

For example, if the fracture is left untreated for a period of time, then you may need an additional reconstructive surgery to improve your use of the ankle. You may also have a permanent deformity of your ankle, difficulty walking, balance issues, or chronic pain. Waiting to have your trimalleolar fracture treated can also result in arthritis.

Pain from the pins and screws can also be a complication of surgery, but the pain can usually be corrected by removing the pins after you have healed completely.

In the majority of cases, people with a trimalleolar fracture achieve complete recovery from their injury. However, it’s important that you seek medical attention if you injure your ankle and the pain persists. The longer you wait to start treatment, the more complications you may have. You may also have a longer recovery period if you wait for treatment.