Ankle Fracture

Aetiology

• Typically an inversion injury with a rotational force applied to the foot

Pathophysiology

• Commonly ankle fractures are multiple and can affect the lateral malleolus, medial malleolus and posterior malleolus (posteroinferior tibia)

• Solitary malleolar fractures are often small avulsion fractures or undisplaced

• Trimalleolar fractures have a particular tendency to instability

Assessment of an ankle fracture

• Weber Classification - A, B, C

• Assess of the stability of the fracture

• Talar shift

Clinical presentation

• Pain and instability

Investigations

• X-ray - AP and lateral views
• Check for soft tissue swelling on x-ray indicating the site of fracture
• Check bony alignment, as non-uniform ankle joint space indicates instability, often with ligamentous damage

• CT can be helpful to clarify fracture anatomy, especially for complex ankle fractures (e.g. Pilon)
• Pilon fractures are high energy fractures which occur at the bottom of the tibia and involves the ankle joint
• Significant soft tissue problems, often other injuries
• Damage to joint may lead to OA

• US and MRI may be needed to define soft tissue injury

Management

• Determined by Weber classification

• Conservative - cast or moonboot

• Operative - ORIF