Ankle fracture

Background

• Always palpate proximal leg to rule-out Maisonneuve Fracture

Diagnosis

Imaging

1. Ottawa Ankle Rules
2. 3 views:
   1. AP - Best for isolated lateral and medial malleolar fractures
   2. Oblique (mortise) - Best for evaluating for unstable fracture or soft tissue injury
      1. At a point 1cm proximal to articular surface of tibia the space between the tib/fib should be ≤6cm
   3. Lateral - Best for posterior malleolar fractures

Classification

Danis-Weber System

• Type A
  • Fibular Fx at or below the joint line without syndesmotic involvement
  • Supination-adduction injury
• Type B
  • Fibular Fx at joint level w/ partial syndesmotic ligament injury
  • Supination-external rotation injury
• Type C
  • Fibular Fx above joint level w/ complete syndesmotic disruption
  • Pronation-eversion injury

Treatment

1. Lateral malleolar Fx
   1. Stable - >90% have good clinical result
      1. Treat like severe ankle sprain
   2. Unstable = displacement >2mm, medial fx, or medial ligament disruption
      1. Medial tenderness indicates need for stress xrays to determine degree of instability
2. Medial or posterior malleolar Fx
   1. Must confirm no other injuries!
   2. If non-displaced, isolated:
      1. Short-leg posterior splint (ankle at 90o)
      2. Non-weight bearing
      3. Refer in 5-7 days
3. Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx
   1. Short-leg posterior splint (ankle at 90o)
   2. Refer within few days for surgical intervention

Disposition

1. Emergent
   1. Open fracture
   2. Fx/dislocation with vascular compromise
   3. Fx/dislocation with significant tenting of the skin
2. Recommended (pt often admitted for repair)
   1. Tillaux/triplane fractures
   2. Intrarticular fractures with displacement
   3. Pilon fractures (reduce if ortho unavailable)
   4. Trimalleolar fractures
   5. Maisonneuve Fx
   6. Any Fx with significant disruption of mortise
3. Recommended (phone is ok)
   1. Bimalleolar Fx
4. Minimally displaced medial or lateral malleolar Fx

See Also

• Ankle Sprain
• Ankle Fracture (Peds)
• Ottowa Ankle Rules
• Maisonneuve Fracture
• Pilon Fracture