Ankle fractures are commonly a low-energy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus.
May be associated with a dislocation of the ankle joint.
Can be associated with a disruption of the tibiofibular syndesmosis.
Displaced fractures are commonly treated with an open reduction and internal fixation.
While other fractures around and including the ankle can occur (such as distal tibial plafond fractures), the term 'ankle fracture' most commonly refers to fracture types in which one or more of either the medial, lateral, or posterior malleolus is broken.
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
Other diagnostic factors
- 'pop' heard on fall
- ankle deformity
- 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
- multiple falls
- low-energy fall
- inversion injury to ankle
- playing sports
1st investigations to order
- plain x-ray
Investigations to consider
- plain x-ray 'stress view' or a standing anteroposterior x-ray
closed fracture + dislocation
isolated lateral malleolar fracture
isolated medial malleolar fracture
- Lateral ankle ligament tear (anterior talofibular ligament and calcaneofibular ligament)
- Achilles tendon rupture
- Talar fracture
- Prevention of surgical site infections after major extremity trauma
- Appropriate Use Criteria: prevention of surgical site infection after high energy extremity trauma
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