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Ankle fractures

Last reviewed: 1 Apr 2025
Last updated: 02 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • recent trauma
  • ankle pain and swelling
  • inability to weight-bear
  • medial and/or lateral malleolus swollen and tender to palpation
Full details

Other diagnostic factors

  • ankle deformity
  • crepitus
  • tenderness of the proximal fibula
  • tenting of the skin over the medial malleolus
  • Ottawa ankle rules
  • history of osteoporosis
  • history of frequent falls
  • vascular compromise
Full details

Risk factors

  • low-energy fall
  • osteoporosis
  • multiple falls
  • inversion injury to ankle
  • playing sports
Full details

Diagnostic tests

1st tests to order

  • plain radiograph
Full details

Tests to consider

  • plain radiograph "stress view" or a standing anteroposterior radiograph
  • CT
  • MRI
Full details

Treatment algorithm

INITIAL

open fracture

closed fracture + dislocation

ACUTE

isolated lateral malleolar fracture

isolated medial malleolar fracture

bimalleolar/trimalleolar fracture

Contributors

Authors

Orthopaedic and Trauma Surgeon

Erasmus MC

Rotterdam

The Netherlands

Disclosures

ESV declares that he has no competing interests.

Consultant Orthopaedic Surgeon

Joint Research

Onze Lieve Vrouwe Gasthuis

Amsterdam

The Netherlands

Disclosures

RWP has been a member of the Dutch Orthopedic Association Committee, has received grants for the ZonMW ESCAPE trial, DART trial, Achmea Escape trial and Van Rens Fonds REDEP trial, and has contributed to the following educational events: the Waldemar Link hip course and the J&J hip course.

Dr Ewout S. Veltman and Dr Rudolf W. Poolman would like to gratefully acknowledge Dr Mohit Bhandari and Dr Brad Petrisor, previous contributors to this topic, as well as Dr Victor A. van de Graaf and Dr Dirk P. ter Meulen for their assistance with the final draft. MB and BP declare that they have no competing interests.

Peer reviewers

Professor of Orthopaedic Surgery

Consultant Orthopaedic Surgeon

Edinburgh Orthopaedic Trauma Unit

Royal Infirmary of Edinburgh

Edinburgh

UK

Disclosures

CCB is an author of several references cited in this topic.

Professor

University of Kentucky School of Medicine

President and Chief Executive Officer

American Board of Family Medicine

Lexington

KY

Disclosures

JCP declares that he has no competing interests.

Clinical Assistant Professor of Medicine

Robert Wood Johnson Medical School

University of Medicine and Dentistry of New Jersey

Piscataway

NJ

Disclosures

PHC declares that he has no competing interests.

References

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Key articles

British Orthopaedic Association Standards for Trauma. The management of ankle fractures​. Aug 2016 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: acute trauma to the ankle. 2020 [internet publication].Full text

American Academy of Orthopedic Surgeons. Prevention of surgical site infections after major extremity trauma: evidence-based clinical practice guideline. Mar 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Ankle fractures images
  • Differentials

    • Lateral ankle ligament tear (anterior talofibular ligament and calcaneofibular ligament)
    • Achilles tendon rupture
    • Talar fracture
    More Differentials
  • Guidelines

    • Fracture management practice guideline
    • Appropriate Use Criteria: prevention of surgical site infection after high energy extremity trauma
    More Guidelines
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