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General Medicine

Ankle Fractures

Jeffrey P. Feden, MD, FACEP Reviewed 06/2019
 


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 e...

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 on O...

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, and associated injuries.

  • Assess joint above/below to avoid overlook...

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FIGURE 33-2. Bimalleolar ankle fractures: open reduction and internal fixation. A: The anteroposterior radiograph demonstrates an isolated fibula fracture. B: A stress view, taken with external rotation of the foot with the ankle in dorsiflexion, documents medial clear space widening and talar shift.
FIGURE 33-2. Bimalleolar ankle fractures: open reduction and internal fixation. A: The anteroposterior radiograph demonstrates an isolated...
FIGURE 33-26. Bimalleolar ankle fractures: open reduction and internal fixation. A and B: Stabilization of the posterior malleolus using two cancellous screws directed from posterior to anterior aspects.
FIGURE 33-26. Bimalleolar ankle fractures: open reduction and internal fixation. A and B: Stabilization of the posterior malleolus using t...
FIGURE 33-27. Bimalleolar ankle fractures: open reduction and internal fixation. Final intraoperative anteroposterior (A), mortise (B), and lateral (C) radio
FIGURE 33-27. Bimalleolar ankle fractures: open reduction and internal fixation. Final intraoperative anteroposterior (A), mortise (B), an...
FIGURE 47-7. (continued) Anteroposterior (B) and lateral (C) radiographs show an unstable supination-external rotation stage IV ankle fracture with the characteristic oblique distal fibula fracture and a medial side injury. D: An anteroposterior radiograph of a supination-adduction ankle fracture with a transverse fibula fracture and an impacted medial malleolar fracture.
FIGURE 47-7. (continued) Anteroposterior (B) and lateral (C) radiographs show an unstable supination-external rotation stage IV ankle frac...
FIGURE 47-9. Schematic diagram and case examples of the AO/OTA classification of ankle fractures. A: There are three types of ankle fractures in the AO/OTA classification: type A, type B, and type C. Each type is further subdivided into three groups. B: An anteroposterior radiograph of a type A distal fibula fracture in which the fracture line is completely below the level of the syndesmosis. C: A radiograph of a type B ankle fracture in which the fibula fracture begins anteriorly at the l...
FIGURE 47-9. Schematic diagram and case examples of the AO/OTA classification of ankle fractures. A: There are three types of ankle fractu...
FIG. 22.37. A radiograph of the left ankle of a 10-year-old boy notable only for soft-tissue swelling localized to the distal fibula (arrows). If the patient is tender over the growth plate, the presumptive diagnosis is a Salter-Harris type I injury.
FIG. 22.37. A radiograph of the left ankle of a 10-year-old boy notable only for soft-tissue swelling localized to the distal fibula (arrow...
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