Ankle fracture

Background

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 tibial plafond space between tib/fib should be ≤6cm
    • Lateral
      • Best for posterior malleolar fractures

Classification (Danis-Weber System)

System based on level of the fibular Fx

Type A (supination-adduction injury)

  • Fibular Fx at or below the joint line (talar mortise) without syndesmotic involvement, typically stable
    • A1: isolated
    • A2: medial malleolus fx
    • A3: posteromedial fx

Type B (supination-external rotation injury)

  • Fibular Fx at joint line (talar mortise) w/ partial syndesmotic ligament injury, stability dictated by integrity of tibiofibular syndesmosis
    • 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 line (talar mortise) w/ complete syndesmotic disruption, unstable and require surgical correction
      • C1: simple diaphyseal fibular fracture
      • C2: complex diaphyseal fibular fracture
      • C3: proximal fracture

Management

  1. Lateral malleolar Fx (isolated)
    1. Treat like severe ankle sprain unless unstable:
      1. Displacement >2mm
      2. Medial fx
    2. Widening of medial clear space (deltoid injury)
  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. Immediate consultation in ED

See Also

Source

  • Tintinalli
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