Ankle fracture

Malleolar Fractures

Isolated Malleolar
Stable if displaced <2mm, joint surface involvement <25%, and no contralateral or syndesmotic injury
Medial Malleolus Fx
Is it really isolated? (frequently associated with lateral or posterior injuries)
Posterior Malleolus Fx
Usually occurs in association w/ post. tibiofibular ligament injury / fibular fx
Rarely occurs in isolation!
Bimalleolar
Lateral + medial malleoli fx
Unstable
Trimalleolar
Lateral + medial + posterior malleoli fx
Requires surgical stabilization

Ottawa Ankle Rules
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 1cm proximal to the articular surface of the tibia the space between the tib/fib should be ≤6cm
Lateral - Best for posterior malleolar fractures

Danis-Weber system:

type A-fibular Fx at or below the joint line without syndesmotic involvement.

type B-fib Fx at joint level with partial syndesmotic ligament injury.

type C-fibular Fx above the joint level and complete syndesmotic disruption.

C-diaphyseal (Dupuytren Fx) or proximal fibular Fx (maissoneuve).

fracture types:

lateral malleolar-Tx depends on type A, B, or C

A-splinting in ED, 6-8 weeks in cast.NWB for three weeks.

B-often requires a surgical repair.

C-surgery usually required.

Lateral malleolar Fx
Stable - >90% have good clinical result
Treat like severe ankle sprain
Unstable = displacement >2mm, medial fx, or medial ligament disruption
Medial tenderness indicates need for stress xrays to determine degree of instability
Medial or posterior malleolar Fx
Must confirm no other injuries!
If non-displaced, isolated:
Short-leg posterior splint (ankle at 90o)
Non-weight bearing
Refer in 5-7 days
Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx
Short-leg posterior splint (ankle at 90o)
Refer within few days for surgical intervention