Ankle Fracture

Yunita Dewi Indriani

20184010127
Anatomy
 “A broken ankle is also known as an ankle
fracture. This means that one or more of the
bones that make up the ankle joint are
broken.”
 Fractures and fracture dislocations of
the ankle are common in adults. Most
are low-energy fractures of one or both
malleoli, usually caused by a twisting
mechanism.
 Mechanism of Injury

 The patient stumbles and falls. Usually the foot is

anchored to the ground while the body lunges
forward. The ankle is twisted and the talus tilts
and/or rotates forcibly in the mortise, causing a
low-energy fracture of one or both malleoli, with
or without associated injuries of the ligaments.

 Ankle fractures are seen in skiers, footballers and

climbers; an older group includes women with
postmenopausal osteoporosis.
 Pull-off or Push-off Fractures
the shape of a fracture indicates which forces were involved

Pull-off Push-off

• A transverse or • An oblique or vertically

horizontal fracture is
the result of a ‘pull-off’.
• The medial malleolus is
pulled off by the
medial collateral
ligament due to
pronation of the foot.
oriented fracture
indicates ‘push-off’.
• The lateral malleolus is
pushed off by
exorotation of the talus.
 Clinical Features

History
A history of a severe twisting Sign
injury
Followed by intense pain and Sign
inability to stand on the leg
Immediate and severe pain
The ankle is swollen and
deformity may be obvious
Bruising
The site of tenderness is
important; if both the medial
and lateral sides are tender,
a double injury (bony or
ligamentous) must be
suspected.
Ottawa Ankle Rules
these rules are used to determine the need for radiographs in patients with
an ankle injury

Ankle X-ray series are only required in case of :

1. Pain in the malleolar zone (bone tenderness of
tip of lateral malleolus and medial malleolus)
2. Innability to bear weight for 4 steps both
immediately and in the emergency
departement
 X-ray
At least three views are needed: anteroposterior, lateral and a 15-
degree internal rotation ‘mortise’ view
 CT Scan MRI Scan
It is especially useful This test provide high
when the fracture resolution images of
extends into the both bones and soft
ankle joint. tissues, like ligaments.
For some ankle
fracture, MRI scan
may be done to
evaluate the ankle
ligaments.
Classification
Danis–Weber
Classification
1 malleolus fx: usually stable (stable fracture with non-displaced
or only slightly displaced fragments can be treated
conservatively)

Bimalleolar fx OR lateral malleolus fx with medial ligament

rupture: unstable (operative treatment)

Pott’s Fracture
• Medial and lateral malleoli
fracture
Bimalleolar

• Medial and lateral malleoli,

and distal tibia (volkmann-
Trimalleolar triangle) fracture
 Treatment :
The first step is to decide whether the injury is
stable or unstable.
Short leg cast for 4- The bone fragments
Reduce joint

Stable/nondisplaced/avulsion

Unstable/displaced
Dislocation

6wk are first repositioned

immediately Regularly to repeat (reduce) into their
ankle x-ray to make normal alignment.
sure the fragments of They are held
fracture have not together with screws
moved out of place and metal plates
during the healing attached to the outer
process. surface of the bone.
The position must be
checked by x-ray
during the period of
healing.
Like other intra-articular injuries, ankle fractures must be accurately
reduced and held.

In assessing the accuracy of

reduction, four objectives must be
met:
the medial joint
the talus must sit space must be
squarely in the restored to its oblique x-rays must
the fibula must be
mortise, with the normal width, i.e. show that there is
restored to its full
talar and tibial the same width as no tibiofibular
length
articular surfaces the tibio-talar diastasis
parallel space (about 4
mm)
 Postoperative Management

 Afteropen reduction and fixation of ankle

fractures, movements should be regained
before applying a below-knee plaster
cast.
 The patient is then allowed partial
weightbearing with crutches; the support
is retained until the fractures have
consolidated (anything from 6–12 weeks).
Reference
 Arastu, M. H., Demcoe, R., & Buckley, R. E. (2012). Current concepts
review: ankle fractures. Acta Chir. Orthop. Traumatol. Cech, 79, 473-
483.
 Brockett, C. L., & Chapman, G. J. (2016). Biomechanics of the ankle.
Orthopaedics and trauma, 30(3), 232-238.
 Goost, H., Wimmer, M. D., Barg, A., Kabir, K., Valderrabano, V., &
Burger, C. (2014). Fractures of the ankle joint: investigation and
treatment options. Deutsches Ärzteblatt International, 111(21), 377.
 Solomon, L., Warwick, D. J., & Nayagam, S. (2014). Apley and
Solomon's Concise System of Orthopaedics and Trauma: ISE Edition.
CRC Press.
 Thompson, J. C. (2015). Netter's Concise Orthopaedic Anatomy,
Updated Edition. Elsevier.