Ankle fracture
Encyclopedia
An ankle fracture is a break of the ankle bone
s. It is typically diagnosed by X-ray. Treatment is with either casting or surgery.
s of an ankle fracture can be similar to those of ankle sprains (pain
), though typically they are often more severe by comparison. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. However, in the setting of an ankle fracture the talus can become unstable and subluxate
or dislocate. Patients may complain of ecchymosis
(brusing), or there may be an abnormal position, abnormal motion, or lack of motion.
and the condition of the nerves and vessels. It is important to palpate
the calf bone (fibula) because there may be an associated fracture proximally (Maisonneuve fracture
), and to palpate the sole of the foot to look for a Jones fracture
at the base of fifth metatarsal (avulsion fracture).
Evaluation of ankle injuries for fracture is done with the Ottawa ankle rules
, a set of rules that were developed to minimize unnecessaryX-rays. There are three x-ray views in a complete ankle series: anteroposterior, lateral, and oblique (or "mortise view"). The mortise view an anteroposterior x-ray taken with the ankle internally rotated until the lateral malleolus is on the same horizontal plane as the medial malleolus, and a line drawn through both malleoli would be parallel to the tabletop, resulting in a position where there normally is no superimposition of tibia and fibula on each other. It usually requires 10 to 20 degrees of internal rotation.
(some of them are called Pott's fracture
s). If the posterior malleolus is also fractured, this is called a trimalleolar fracture
.
. The Lauge-Hansen system classifies fractures based on the mechanism of the injury as it relates to the position of the foot and the deforming force (most common type is supination-external rotation). The Danis-Weber system classifies an ankle fracture by the level of the fracture of the distal fibula (type A = below the syndesmotic ligament, type B = at its level, type C = above the ligament). A special form of type C fracture is the Maisonneuve fracture
, which involves a fracture of the fibula far above the ankle joint itself. This occurs in the setting of injury to the syndesmosis and the interosseous membrane
.
or splint
will be required to immobilize the ankle following surgery.
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
s. It is typically diagnosed by X-ray. Treatment is with either casting or surgery.
Signs and symptoms
SymptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s of an ankle fracture can be similar to those of ankle sprains (pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
), though typically they are often more severe by comparison. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. However, in the setting of an ankle fracture the talus can become unstable and subluxate
Subluxation
A subluxation may have different meanings, depending on the medical specialty involved. It implies the presence of an incomplete or partial dislocation of a joint or organ. The World Health Organization defines both the medical subluxation and the chiropractic subluxation...
or dislocate. Patients may complain of ecchymosis
Ecchymosis
An ecchymosis is the medical term for a subcutaneous purpura larger than 1 centimeter or a hematoma, commonly called a bruise. It can be located in the skin or in a mucous membrane.-Presentation:...
(brusing), or there may be an abnormal position, abnormal motion, or lack of motion.
Evaluation
On clinical examination, it is important to evaluate the exact location of the pain, the range of motionRange of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
and the condition of the nerves and vessels. It is important to palpate
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
the calf bone (fibula) because there may be an associated fracture proximally (Maisonneuve fracture
Maisonneuve fracture
The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament...
), and to palpate the sole of the foot to look for a Jones fracture
Jones fracture
A Jones fracture is a fracture of the diaphysis of the fifth metatarsal of the foot. The fifth metatarsal is at the base of the small toe. The proximal end, where the Jones fracture occurs, is in the midportion of the foot. Patients who sustain a Jones fracture have pain over this area, swelling,...
at the base of fifth metatarsal (avulsion fracture).
Evaluation of ankle injuries for fracture is done with the Ottawa ankle rules
Ottawa ankle rules
In medicine, the Ottawa ankle rules are a set of guidelines for doctors to aid them in deciding if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been X-rayed...
, a set of rules that were developed to minimize unnecessaryX-rays. There are three x-ray views in a complete ankle series: anteroposterior, lateral, and oblique (or "mortise view"). The mortise view an anteroposterior x-ray taken with the ankle internally rotated until the lateral malleolus is on the same horizontal plane as the medial malleolus, and a line drawn through both malleoli would be parallel to the tabletop, resulting in a position where there normally is no superimposition of tibia and fibula on each other. It usually requires 10 to 20 degrees of internal rotation.
X ray
On X-rays, there can be a fracture of the medial malleolus, the lateral malleolus, or of the anterior/posterior margin of the distal tibia. The posterior margin (known as the posterior malleolus), is much more frequently injured than the anterior aspect of the distal tibia. If both the lateral and medial malleoli are broken, this is called a bimalleolar fractureBimalleolar fracture
A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities....
(some of them are called Pott's fracture
Pott's fracture
Pott's fracture, , also known as Pott’s syndrome I and Dupuytren fracture, is an archaic term loosely applied to a variety of bimalleolar ankle fractures. The injury is caused by a combined abduction external rotation from an eversion force...
s). If the posterior malleolus is also fractured, this is called a trimalleolar fracture
Trimalleolar fracture
A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, medial malleolus and the distal posterior aspect of the tibia, which can be termed the posterior malleolus....
.
Classification
There are several classification schemes for ankle fractures, including the Lauge-Hansen classification and the Danis-Weber classificationDanis-Weber classification
The Danis-Weber classification is a method of describing Ankle fractures. It has 3 categories:A * below level of the ankle joint * tibiofibular syndesmosis intact * deltoid ligament intact...
. The Lauge-Hansen system classifies fractures based on the mechanism of the injury as it relates to the position of the foot and the deforming force (most common type is supination-external rotation). The Danis-Weber system classifies an ankle fracture by the level of the fracture of the distal fibula (type A = below the syndesmotic ligament, type B = at its level, type C = above the ligament). A special form of type C fracture is the Maisonneuve fracture
Maisonneuve fracture
The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament...
, which involves a fracture of the fibula far above the ankle joint itself. This occurs in the setting of injury to the syndesmosis and the interosseous membrane
Interosseous membrane
An interosseous membrane is a broad and thin plane of fibrous tissue that separates many of the bones of the body. It is an important component of many joints.Interosseous membranes in the human body:* Interosseous membrane of the forearm...
.
Treatment
Treatment of ankle fractures is dictated by the stability of the ankle joint. Certain fracture patterns are deemed stable, and may be treated similar to ankle sprains. All other types require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs. A castOrthopedic cast
An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...
or splint
Splint
Splint may refer to:* Splint , a medical device for the immobilization of limbs or spine* Splint , a device for checking computer programs...
will be required to immobilize the ankle following surgery.