Ankle fractures

Last revised by Joachim Feger on 08 Jan 2022

Ankle fractures account for ~10% of fractures encountered in trauma, preceded only in incidence by proximal femoral fractures in the lower limb. They have a bimodal presentation, involving young males and older females. Ankle injuries play a major part in functional impairment after multi or polytrauma thereby necessitating a detailed evaluation.  

The first classification system was proposed by Percival Pott 3, describing fractures in terms of malleoli involved: unimalleolar, bimalleolar, and trimalleolar. Despite its ease to identify fractures and decreased inter/intraobserver variability, it has been superseded by two systems of classification which takes into consideration the rotational mechanism of injury and the stability of the fracture; each has its own advantages and disadvantages:

An approach to reading an ankle radiograph can be read here.

Results following the anatomic reduction of a displaced ankle fracture are good. Post-traumatic arthritis has been reported in ~15% of patients despite an anatomic reduction, likely due to chondral injury 7

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Cases and figures

  • Case 1: medial malleolus fracture
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