Ankle fracture

Background

• Always palpate proximal leg to rule-out Maisonneuve Fracture

Imaging

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

Classification (Danis-Weber System)

• Type A (supination-adduction injury)
  • Fibular Fx at or below the joint line without syndesmotic involvement
    • A1: isolated
    • A2: medial malleolus fx
    • A3: posteromedial fx
• Type B (supination-external rotation injury)
  • Fibular Fx at joint level w/ partial syndesmotic ligament injury
  • B1: isolated
  • B2: medial lesion (either malleolus or ligament)
  • B3: medial lesion and fx of posterolateral tibia
• Type C (pronation-eversion injury)
  • Fibular Fx above joint level w/ complete syndesmotic disruption
    • C1: simple diaphyseal fibular fracture
    • C2: complex diaphyseal fibular fracture
    • C3: proximal fracture

Management

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 rule-out other injuries
   2. If non-displaced, isolated:
      1. Short-leg posterior splint (ankle at 90')
      2. Non-weight bearing
      3. Refer in 5-7d
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

See Also

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

Source

• Tintinalli