Ankle fractures

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.

Vascular compromise is rare and is usually the result of fracture-dislocations.

Proper immobilisation, analgesia, and timely orthopaedic referral as appropriate can greatly enhance patient comfort and ensure optimal outcome. Some non-displaced or anatomically reduced ankle fractures can be treated conservatively, but consultation with an orthopaedist is generally recommended.

Displaced fractures are commonly treated with an open reduction and internal fixation.

Open fractures require emergency treatment by experienced surgeons including saline irrigation, wound debridement, and removal of all devitalised tissue and foreign debris.

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. It may be associated with dislocation of the ankle joint. Maisonneuve's fracture is a high fracture of the fibula with a concomitant separation of the tibiofibular syndesmosis and fracture of the medial malleolus or rupture of the medial ankle ligament complex, essentially representing a dissociation of the tibia and fibula below the level of the fibula fracture.[1]Inokuchi R, Jujo Y, Iwashita K, et al. Maisonneuve fracture: a type of ankle fracture. BMJ Case Rep. 2019 Nov 4;12(11):e231961. https://casereports.bmj.com/content/12/11/e231961.long

This topic does not include the management of other fractures around and including the ankle such as distal tibial plafond fractures (also known as pilon fractures).