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
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
Risk factors
- osteoporosis
- multiple falls
- low-energy fall
- inversion injury to ankle
- playing sports
Diagnostic investigations
1st investigations to order
- plain radiograph
Investigations to consider
- plain radiograph "stress view" or a standing anteroposterior radiograph
- CT
- MRI
Treatment algorithm
open fracture
closed fracture + dislocation
isolated lateral malleolar fracture
isolated medial malleolar fracture
bimalleolar/trimalleolar fracture
Contributors
Authors
Ewout S. Veltman, MD
Orthopedic 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.
Differentials
- Lateral ankle ligament tear (anterior talofibular ligament and calcaneofibular ligament)
- Achilles tendon rupture
- Talar fracture
More DifferentialsGuidelines
- 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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