Pott's Fracture

What is a Pott's Fracture?

A fracture to the lateral, medial or posterior malleoli (bony parts on the outside and inside of the ankle respectively) is known as Pott's fracture. It is often caused in the same way as an ankle sprain so can be difficult to tell apart initially. Lateral ankle sprains are more common and so fractures to the lateral malleoli also tend to occur more frequently.

Initially, careful palpation of the malleolus and surrounding area can indicate that a fracture may or may not be present. Maximal tenderness on the bone may indicate a fracture, whereas if the area just forward or under the bone is more tender, this indicates a ligament sprain.

However, x-ray is the only way to determine for definite if a fracture is present. Early x-rays may not clearly show this due to swelling and bleeding in the area and so if a fracture is suspected, then a second x-ray may be requested once this has decreased.

Symptoms of Pott's Fracture

• Instant, severe pain
• Unable to put weight on the injured leg.
• Tenderness at the point of the fracture, usually over the malleolus.
• Considerable swelling and bruising

Treatment of Pott's Fracture

• Depending on the severity of the injury surgery may be required to fix internal bones of the ankle which may have moved.
• Spiral fractures of the lateral malleolus and posterior malleolus do not usually require fixation and are treated without surgery using crutches and mobilization exercises early on.
• Lateral malleolar fractures with instability on the inside of the ankle and hairline medial malleolar fractures could become unstable and are usually treated with a plaster cast fitted below the knee for 6 weeks.
• Less severe fractures may be treated with an ankle brace or walking boot.
• A full strengthening and ankle rehabilitation programme should be undertaken to include wobble board or proprioception training.