Ankle fractures

Last reviewed: 23 Aug 2023
Last updated: 25 Aug 2022



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

Diagnostic investigations

1st investigations to order

  • plain radiograph
More 1st investigations to order

Investigations to consider

  • plain radiograph "stress view" or a standing anteroposterior radiograph
  • CT
  • MRI
More investigations to consider

Treatment algorithm


open fracture

closed fracture + dislocation


isolated lateral malleolar fracture

isolated medial malleolar fracture

bimalleolar/trimalleolar fracture



Ewout S. Veltman, MD

Orthopedic and Trauma Surgeon

Erasmus MC


The Netherlands


ESV declares that he has no competing interests.

Rudolf W. Poolman, MD, PhD

Consultant Orthopaedic Surgeon

Joint Research

Onze Lieve Vrouwe Gasthuis


The Netherlands


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

Charles Court-Brown, MB ChB

Professor of Orthopaedic Surgery

Consultant Orthopaedic Surgeon

Edinburgh Orthopaedic Trauma Unit

Royal Infirmary of Edinburgh




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

James C. Puffer, MD


University of Kentucky School of Medicine

President and Chief Executive Officer

American Board of Family Medicine




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




PHC declares that he has no competing interests.

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