Ankle fracture
Classification
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.
medial malleolar Fx-rare. non dispalced Fx usually managed with closed reduction and casting for 6 weeks (up to 15% nonunion rate unfortunately...). If displaced
Bimalleolar Fx-by definition unstable-needs ORIF
trimalleolar-bimalleolar with an accompanying Fx of the posterior lip of the talus.
Disposition
Ortho Consult Guidelines:
Emergent-open fracture,Fx/dislocation with vascular compromise.Fx/dislocation with significant tenting of the skin.
Recommended (pt often admitted for repair)-tillaux/triplane fractures,intrarticular fractures with displacement, pilon fractures (reduce if ortho unavailable), trimalleolar fractures, maisonneuve Fx, any Fx with significant disruption of mortise.
Recommended (phone is ok)
bimalleolar Fx, minimally displaced medial or lateral malleolar Fx.
Treatment
non-displaced close Fx w/ intact mortise-casted for 6 weeks.
disruption of ankle mortise alignment >1-2 mm (lateral alignment more important than medial) needs ORIF.
Complications
malunion
nonunion
chronic pain
traumatic arthritis
avascular necrosis
chronic instability
fracture blisters and skin necrosis from swelling
compartment syndrome
post surg wound infection/osteo
See Also
Ortho: Maisonneuve
Ortho: Pilon Fx
Ortho: Ankle (Ottowa)
Ortho: Ankle (Sprain)