Ver el código de «Ankle fracture»

==Background==

==Clinical Features==
*Examine for ecchymoses, abrasions, or swelling
*vascular and neurologic assessment
**DPs and PTs
**4 sensation distributions: saphenous nerve (medial mal), superficial fib (lat mal), sural nerve (lateral 5th digit), deep fib (1st web space)
*Note skin integrity and areas of tenderness or crepitus over ankle
*Range joint passively and actively to evaluate for stability
*Examine Joints above and below the ankle
*Perform anterior drawer test (positive exam suggests torn ATFL)
*'''Always palpate entire length of fibula to rule-out [[Maisonneuve Fracture]] (fibulotibialis ligament tear)'''
**Perform a crossed-leg test to detect syndesmotic injury
*Evaluate integrity of Achilles tendon ([[Achilles Tendon Rupture#Clinical Features|Thompson test]])
*Palpate midfoot and base of 5th metatarsal for tenderness

==Differential Diagnosis==
{{Other ankle injuries DDX}}

{{Distal leg fractures DDX}}

{{Foot and toe fractures DDX}}

==Diagnosis==
[[File:WeberARadiopediaOB.jpg|thumb|Weber A Oblique]]
[[File:WeberBRadiopedOB.jpg|thumb|Weber B Oblique]]
[[File:WeberBAPMedp.jpg|thumb|Weber B AP]]
[[File:WeberCOBMedp.jpg|thumb|Weber C Oblique]]
[[File:WeberCAPMedp.jpg|thumb|Weber C AP]]

*[[Ottawa Ankle Rules]] (sen 96-99% for excluding fracture)
*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 1 cm proximal to tibial plafond space between tib/fib should be ≤6mm
**Lateral: Best for posterior malleolar fractures
*consider proximal tib/fib films and talus fractures

===Classification (Danis-Weber System)===
[[File:WeberclassRadioped.jpg|thumb|]]
*system based on level of the fibular fracture and characterizes stability of fracture
*tibial plafond and the two malleoli is referred to as the ankle "mortise" (or talar mortise)

====Type A====
*fibula fracture below ankle joint/distal to plafond
**medial malleolus often fractured
**tibiofibular syndesmosis intact
**usually stable: occasionally requires ORIF

====Type B====
*fibula fracture at the level of the ankle joint/at the plafond
**can extend superiorly and laterally up fibula
**tibiofibular syndesmosis intact or only partially torn
**no widening of the distal tibiofibular articulation
**medial malleolus may be fracture
**possible instability

====Type C====
*fibula fracture above the level of the ankle joint/proximal to plafond
**tibiofibular syndesmosis disrupted with widening of the distal tibiofibular articulation
**medial malleolus fracture
**unstable: requires ORIF

==Management & Disposition==
*Determined by stability of fracture: 
**Stable, nondisplaced, isolated malleolar fracture: Splint or cast, early wt bearing, RICE 
**Unstable or displaced fracture: Requires ORIF, ortho consult, reduce and splint

===Isolated lateral malleolar fracture===
*If stable (see Weber classification) treat like severe [[Ankle Sprain]] 
*Signs of instability: 
**Displacement >3mm 
**Associated medial malleolus fracture 
**Signs of medial (deltoid) ligament disruption such as medial swelling, ecchymosis, or TTP 
**Widening of medial clear space (suggests deltoid ligament injury) 

===Isolated medial or posterior malleolar fracture===
*Must rule-out other injuries 
*If non-displaced, isolated: 
**[[Short-Leg Posterior Splint]] (ankle at 90<sup>o</sup>) 
**Non-weight bearing 
**Refer to Ortho in 5-7d 

===Lateral malleolar fracture with deltoid injury OR bimalleolar OR trimalleolar fracture===
*[[Short-Leg Posterior Splint]] (ankle at 90<sup>o</sup>) 
*Immediate reduction or ortho consult in ED

==See Also==
*[[Ankle (Main)]]
*[[Ankle Sprain]]
*[[Ankle Fracture (Peds)]]
*[[Ottowa Ankle Rules]]
*[[Maisonneuve Fracture]]
*[[Pilon Fracture]]
*[[Fracture (Main)]]
*[[Splinting]]

==References==
<references/>
, Uptodate, Medpix Radiology Teaching Files (Images by Dr. Timothy Sanders)
*http://radiopaedia.org/articles/weber_ankle_fracture_classification (Images by Dr. Frank Gaillard; CC SA NC BY licence)
*Ottawa Ankle Rules - http://www.ncbi.nlm.nih.gov/pubmed?term=12595378
[[Category:Orthopedics]]