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Ankle fractures are not always like this, thankfully
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This is more typical, isolated fibular fracture
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Ankle fractures are one of the most common fractures seen
nationally.
Mechanism of injury:
- Falls
- Slips
- Twists
- Sports
Non-operative fractures:
-
90% SERII
- 5% Pron-abduction I-II
- < 1% isolated posterior malleolar fractures
- < 1% Supination-adduction I
Operative
fractures:
- 60% SERIV
- 38% PERIV
- >.07% Pron-abduction II-III
- >.01% Supination-adduction I-II
Specific
injuries:
- 75% Deltoid
- 25% Maisonneuve
- < 1% Posterior malleolar
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Fracture Classifications:
- AO (not the most helpful or
descriptive)
- Lauge-Hansen (very descriptive)
AO:
A - Below the ankle
B - At the level of the ankle
C
- Above the ankle
Lauge-Hansen:
- Supination-Adduction (I-II)
- Supination-External Rotation (I-IV)
- Pronation-Abduction
(I-III)
- Pronation-External Rotation (I-IV)
Supination-Adduction
1st part - position of the talus
2nd part
- direction the talus is moving
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Indications for surgery:
- Displaced fracture >~3mm
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Unstable fracture pattern
- Mortise widening >~3mm
- Posterior malleolar fragment >25%
- Shortened fibula >~2mm
Fixation
Options:
- Screws
- Plates
- Locking plates
- Tension bands
- K-wires
- Rush rods
Fixation techniques:
-
Interfragmental compression
- Buttress plates
- Neutralization plates
- Anti-glide plates
- Splintage
- External
fixation
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Majority of hardware never needs to be removed.
Syndesmotic
screws should be removed between 8-12 weeks.
Types of materials:
- Stainless steel
- Titanium
- Absorbable
Ankle
fractures should take 4-6 months for full recovery.
Long-term complications can and will occur.
Ankle fractures
may require an ankle arthroscopy at 8-12 months post injury to remove scar tissue from the joint.
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More common complication: medial malleolar nonunion
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Fibular nonunions can occur
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