Ankle Fractures Flashcards
What is an ankle fracture?
Fracture of the malleolus (lateral, medial, posterior) with or without disruption to the syndesmosis
Who presents most commonly with ankle fractures?
Young males
Older females
How can ankle fractures be described anatomically?
- Isolated medial malleolar fractures
- Isolated lateral malleolar fractures
- Bimalleolar fractures
- Trimalleolar fractures
What is the Weber classification?
- Type A = Below the syndesmosis
- Type B = At the level of the syndesmosis
- Type C = Above the level of the syndesmosis
What are the symptoms & signs of ankle fractures?
Symptoms
- Ankle pain
- Following traumatic injury
- Unable to weight bear
- Deformity (in cases of ankle dislocation)
Signs
- Focal tenderness at fracture site
What should you include in the examination of a potential ankle fracture?
- Check the neurovascular status
- Check for evidence of open fracture or compromise to overlying skin
- Assess for Ottawa ankle rules
- Check for concomitant injuries
What are the Ottawa ankle rules?
Useful clinical decision aide to help determine whether radiographic imaging is required for ankle / foot trauma. Imagine is required with pain in malleolar region and:
- Bone tenderness at the posterior edge / tip of the lateral malleolus
- Bone tenderness at the posterior edge / tip of the medial malleolus
- Inability to weight bear both immediately and in the ED for four steps
What are the limitations of the Ottawa ankle rules?
Can’t be used in cases if the patient:
- Is intoxicated / unncooperative
- Has distracting painful injuries
- Has diminished sensation in their legs
- Has gross swelling
What investigations would you request for a suspected ankle fracture?
- Plain radiograph
- AP / Mortise view & Lateral view
- Check for uniformity & evidence of talar shift
- CT imaging
* May be required in cases of complexity or diagnostic uncertainty
What is the management for ankle fractures?
Conservative
- Reduction (under sedation)
- Place in below knee back slab, repeat neurovascular examination & plain radiographs
- May need to repeat reduction if unsuccessful first time
Surgical
- Open reduction & internal fixation (ORIF)
* To achieve stable anatomical reduction
What type of ankle fractures will typically be managed conservatively?
- Non-displaced medial malleolar fracture
- Weber A / B fractures without talar shift
- Patients unfit for surgical intervention
What type of ankle fractures are typically managed with ORIF?
- Bimalleolar / Trimalleolar fractures
- Weber C / B with talar shift
- Open fracture
What are the potential complications following an ankle fracture?
- Post-traumatic arthritis
- Rare in cases with appropriate reduction & fixation
- Surgical site infection (with ORIF)
- Malunion (with ORIF)
What are ankle sprains?
Ligamentous injuries - the main differential for an ankle fracture
How can ankle sprains be classified?
- High ankle sprains = Injuries to the syndesmosis
- Low ankle sprains = Injuries to the ant. tibiofibular ligament (ATFL) & calcaneofibular ligament (CFL)
What is the typical presentation of patients with ankle sprains?
- Inversion injury on plantarflexed ankle
- Swelling & pain
- May be unable to weight bear
What investigation may be used in suspected ankle sprain?
Plain film radiographs
- To rule out bony injury
How are ankle sprains typically managed?
Conservative management:
- Analgesia
- Ice
- Elevation
- Early mobilisation
