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Ankle Fractures

Jeffrey P. Feden, MD, FACEP Reviewed 06/2018
 


BASICS

  • Bones: tibia, fibula, talus

  • Mortise: tibial plafond, medial and lateral malleolus

  • Ligaments: syndesmotic, lateral collateral, and medial collateral (deltoid) ligament

DESCRIPTION

  • Two common classif...

DIAGNOSIS

HISTORY

  • Location of pain, timing, and mechanism of injury (key historical element is exact mechanism)

  • Weight-bearing status after injury

  • History of ankle injury or surgery

  • Tetanus status

  • Assess f...

TREATMENT

GENERAL MEASURES

  • Immobilize in temporary cast/splint and protect with crutches/non–weight bearing

    • 1 to 2 weeks to allow decreased swelling, if not open or irreducible fracture (2)[C]

  • Ice and ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Orthopedic follow-up: serial x-rays

    • In children, sclerotic lines on x-ray (Parker-Harris growth arrest lines) indicate growth disturbance (5)[C...

REFERENCES

1 Polzer H, Kanz KG, Prall WC, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia).  2012;4(1):e5.  [View Abstract]

CODES

ICD10

  • S82.899A Oth fracture of unsp lower leg, init for clos fx

  • S82.899B Oth fracture of unsp lower leg, init for opn fx type I/2

  • S82.56XA Nondisp fx of medial malleolus of unsp tibia, init

  • S82.66XA...

CLINICAL PEARLS

  • OAR are nearly 100% sensitive in determining the need for x-rays.

  • Assess neurovascular status, ability to bear weight, associated injuries.

  • Assess joint above/below (i.e., Maisonneuve).

  • N...

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