- Ankle fractures are the commonest lower limb fractures
- Occur following high-energy impacts or low-energy twists
- Low-energy twists cause rotation of the talus within the joint
- Occurs if foot is internally or externally rotated
Classification
- Weber classification is based on the level of the fibular fracture in
relation to the syndesmosis
- Does not take account of other injuries (e.g. medial malleolus)
- Type A - below
- Type B - at the level (often spiral or oblique)
- Type C - above
- Lauge-Hansen classification is based on the position of the foot and
direction of deforming force
Investigation
- Plain AP and lateral ankle radiographs show fracture / dislocation
- A mortice view (10-20 degrees) in line with the intermalleolar line my
show diastasis
- Diastasis is widening of the gap between the tibia and fibular
Management
- Suspected ankle fractures should be promptly assessed
- Fracture-dislocations should be reduced and stabilised
- This is required to prevent overlying skin necrosis
- Future management depends on facture type and stability
Undisplaced fractures
- Type A injuries are stable and require minimal splintage
- Type B injuries confined to the lateral part of the ankle are also
stable
- Type C often look undisplaced but there is often significant ligament
injury
- Consideration should be given to examination under anaesthesia and
fixation
Displaced fractures
- The majority of these fractures require open reduction and fixation
- Medial and posterior malleoli are fixed with lag screws
- The fibular farcture is stabilised with a plate
Bibliography
Abbassian A, Thomas R. Ankle ligament injuries. Br J
Hosp Med 2008; 69: 339-343.
Dattani R, Patnaik S, Kantak A et al. Injuries
to the tibiofibular syndesmosis. J Bone Joint Surg Br 2008;
90: 405-410.
Oussedik A. Ankle fractures. Br J Hosp Med 2006;
67: 156-158.
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