Ankle fractures

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Last reviewed: 4 Sep 2022
Last updated: 25 Aug 2022

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
More key diagnostic factors

Other diagnostic factors

  • 'pop' heard on fall
  • 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
Other diagnostic factors

Risk factors

  • osteoporosis
  • multiple falls
  • low-energy fall
  • inversion injury to ankle
  • playing sports
More risk factors
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Diagnostic investigations

1st investigations to order

  • plain x-ray
More 1st investigations to order

Investigations to consider

  • plain x-ray 'stress view' or a standing anteroposterior x-ray
  • CT
  • MRI
More investigations to consider
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Treatment algorithm

INITIAL

open fracture

closed fracture + dislocation

ACUTE

isolated lateral malleolar fracture

isolated medial malleolar fracture

bimalleolar/trimalleolar fracture

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Contributors

Authors

Ewout S. Veltman, MD

Orthopaedic and Trauma Surgeon

Erasmus MC

Rotterdam

The Netherlands

Disclosures

ESV declares that he has no competing interests.

Rudolf W. Poolman, MD, PhD

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.

Acknowledgements

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

Charles Court-Brown, MB ChB

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.

James C. Puffer, MD

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.

Philip H. Cohen, MD

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.

  • Ankle fractures images

  • Differentials

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

  • Guidelines

    • Prevention of surgical site infections after major extremity trauma
    • Appropriate Use Criteria: prevention of surgical site infection after high energy extremity trauma
    More Guidelines
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