CHAPTER 16.

ANKLE FRACTURES (TIBIA AND FIBULA)

DESCRIPTION

Ankle fractures are breaks of the distal tibia or fibula (near or in the so-called malleolus) affecting the tibiotalar
(ankle) joint. Occasionally, they involve the shaft of the fibula as well. Ankle fractures range from simple injuries
of a single bone to complex ones involving multiple bones and ligaments. Twisting with the foot planted on
the ground and the body rotating around it is the most common mechanism of injury. Compression loading
(ex. from a fall) is more apt to produce a fracture of the weight-bearing surface of the distal tibia (the plafond).
These are designated as “pilon fractures,” and are considered distinctly different injuries. Ankle fractures can
be broadly divided into stable or unstable injuries. Stable fractures typically heal with immobilization and
protected weight-bearing whereas operative management is usually required for displaced or unstable fractures.
Ankle fractures directly or indirectly involve the ankle joint. Some residual ankle arthrosis is therefore not
uncommon, even if the bone heals perfectly.

STRUCTURE AND FUNCTION: ANKLE ANATOMY

The ankle joint is made up of the tibia, fibula, and talus (Figure 1). The tibia forms the superior and medial
aspects of the joint, and the fibula its lateral aspect. The talus is a cube-shaped bone that sits above the calcaneus
and below the tibial plafond. The distal ends of the fibula and tibia that overlap the talus are known as the
malleoli (“little hammers”). The lateral malleolus is the distal end of the fibula, whereas the medial and posterior
malleoli are part of the tibia. A fracture affecting both the medial and lateral malleoli is called a bimalleolar
fracture, and one involving the medial, lateral, and posterior malleoli, the posterior aspect of the distal tibia, is
called a trimalleolar fracture.

The ankle joint also contains three important ligament complexes:

1. The deltoid ligament medially, connecting the tibia to the talus and calcaneus medially.
2. The anterior and posterior talo-fibular, and calcaneo-fibular ligaments (collectively, the lateral collateral
ligaments); and
3. The anterior and posterior distal tibiofibular ligaments or syndesmosis, which connects the distal tibia and
fibula above the tibio-talar joint line.

110 PINNEY