![]() In potentially unstable fractures treated non-operatively with cast application, it may be necessary to follow the patient weekly with serial x-rays to assess the position of the fracture, with cast removal at approximately 6 weeks depending on clinical and radiographic evidence of healing. This requires a detailed discussion with the patients and a shared decision-making. Patients were offered a choice of a weight bearing below knee cast a functional ankle brace or a regime of rest, ice, compression bandage and elevation. They reviewed 163 patients with stable ankle fractures over a period of 8 years. Hutchinson and Barrie suggested that the majority of ankle fractures seen in clinic are stable, are not likely to displace and do not require plaster casting to achieve union in a good position. Non-operative management includes immobilisation with plaster cast or boot, either weight-bearing or non-weight-bearing, for 6 weeks or functional management with controlled range of motion and combinations of non-weightbearing or weight-bearing may also be considered. ![]() The choice of conservative or surgical management depends on the patient and whether the fracture is ‘stable’ or ‘unstable’. Management of ankle fractures depends on accurate determination of the nature and severity of the injury. Plain radiographs will give the diagnosis in most cases although CT may be useful in understanding complex fracture patterns to map out fracture anatomy and for surgical planning. Patients should be treated according to BOA standards for trauma (BOAST). It can be distinguised from the SER or PER patterns through the display of of comminuted fracture of fibula which occurs with a bending force that spits out a butterfly fragment. Pronation-external rotation (PER 4 stages)įracture is proximal to the syndesmosis and may be as high as fibular neck (Maisonneuve) with associated syndesmotic injury.įracture is either at the level of above the level of the syndesmosis. The SER4 fracture has a medial component: either a medial malleolar fracture or a deltoid rupture, and may require surgery depending upon on reduction in a weight bearing position. Most common ankle fracture occuring at the level of the syndesmosis. The SER2 has no medial injury, is mechanically stable and do not require surgery. Supination-external rotation (SER 4 stages) Transverse fracture of the lateral malleolus inferior to the ankle joint (SA1) with classically vertical shear fracture of the medial malleolus (SA2). This is based on (1) the position of the foot at the time of injury and (2) the deforming force on the ankle. Subluxed or dislocated ankles will classically have the foot in a more anterior or externally rotated position than normal with tenting of the bone on the skin.Ĭlassification Danis-Weber Classificationī - Fracture at the level of the syndesmosisĬ - Fracture above the syndesmosis Lauge-Hansen Classification Patients typically present after an injury (although note neuropathic patients including diabetics may not recall one due if they are insensate) with pain, swelling and deformity. Isolated distal fibular or lateral malleolus fractures occur in two thirds of patients, bimalleolar fractures occur in a quarter and trimalleolar fractures in the remaining 7%. They have a bimodal age distribution with peaks in younger males and older females. They are the second most common fracture in adults (9%) after femoral neck fractures. The incidence of ankle fractures is ~180 fractures per 100,000 people in the population per year. ![]() ![]() Although pilon and talar body fractures are included in the ankle joint anatomically, they are considered distinct injuries in their own right and will be discussed elsewehere. Ankle fractures refer to fractures of the malleoli. ![]()
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