ANKLE FRACTURE

Highly susceptible to
injury because they
are relatively mobile
and weight bearing
(support more weight
per unit area than any
other joint)

Incidence: USA 15%

of ankle injuries

Anatomy
Bone

Tibia distal
Fibula distal
Talus

Anatomy
Three groups of stabilizing ligaments :
1.
2.
3.

Syndesmotic ligaments
Lateral collateral ligaments
Medial collateral ligaments

Anatomy
1.

Syndesmotic ligaments

Anteroinferior tibiofibular (AITFL), posteroinferior tibiofibular (PITFL), inferior transverse ligament (ITL), interosseus ligament
(IOL)

Maintains the integrity of the distal tibia and the fibula

and resist the axial, rotational, and translational forces

Anatomy
2. Lateral ligament

anterior talofibular ligament

(ATFL)
calcaneofibular ligament
(CFL)
posterior talofibular ligament
(PTFL).
limit ankle inversion and
prevent anterior and lateral
subluxation of the talus

Anatomy
3. Medial (deltoid)
- Superficial
. Talotibial, naviculotibial,
calcaneotibial
- Deep
.run transversly from post
colliculus of tibia to the talus

stabilize the joint

during eversion and prevent
talar subluxation

Classification
Lauge-Hansen
Position of the foot and the forces acting
at the time of injury
Foot position : supination, pronation
Deforming force : external rotation,
abduction, or adductio

Classification
SUPINATION-EVERSiON
(EXTERNAL ROTATION) (SER)
1.
2.
3.

4.

Disruption of the anterior

tibiofibular ligament
Spiral oblique fracture of the
distal fibula
Disruption of the posterior
tibiofibular ligament or fracture
of the posterior malleolus
Fracture of the medial
malleolus or rupture of the
deltoid ligament

Classification
SUPINATION-ADDUCTION
(SA)
1.

2.

Transverse avulsion-type
fracture of the fibula
below the level of the
joint or tear of the lateral
collateral ligaments
Vertical fracture of the
medial malleolus

Classification
PRONATION-EVERSON
(EXTERNAL
ROTATION) (PER)
1.

2.
3.
4.

Transverse fracture of the medial

malleolus or disruption of the
deltoid ligament
Disruption of the anterior
tibiofibular ligament
Short oblique fracture of the
fibula above the level of the joint
Rupture of posterior tibiofibular
ligament or avulsion fracture of
the posterolateral tibia

Classification
PRONATION-ABDUCTION (PA)
1.

2.

3.

Transverse fracture of the

medial malleolus or rupture of
the deltoid ligament
Rupture of the syndesmotic
ligaments or avulsion fracture
of their insertion(s)
Short, horizontal, oblique
fracture of the fibula above
the level of the joint

Classification
Danis-Weber
Based on the location
and appearance of the
fibular fracture
Emphasizes the
importance of the lateral
side of the ankle
Useful in planning
surgical treatment

Classification
Weber type A
caused by internal
rotation and adduction
transverse fracture of the
lateral malleolus at or
below the plafond, with
or without an oblique
fracture of the medial
malleolus.

Classification
Weber type B
caused by external
rotation
oblique fracture of the
lateral malleolus,. The
injury may include
rupture or avulsion of the
anteroinferior tibiofibular
ligament, fracture of the
medial malleolus, or
rupture of the deltoid
ligament.

Classification
Weber Type C
C-1 : Abduction injuries, oblique
fracture of the fibula proximal to
the disrupted tibiofibular
ligaments
C-2 : Abductionexternal rotation
injuries interosseous membrane,
medial malleolar fracture or a
deltoid ligament rupture.

Diagnosis
X-rays
Indications :
Bony tenderness at the posterior edge or tip of the medial / lateral
malleolus.

Views
AP, lateral, mortise view (15-20 degrees of internal rotation)
AP : malleoli, plafond, talar dome, lateral process of the talus
Lateral : ant/post tibial margins, talar neck, post, talar process and
calcaneus
Mortise : most important view, medial clear space should not
exceed 4mm

Diagnosis
CT-Scan and MRI
To asses the complexity of the fracture
and any associated ligamentous and
intraarticular injuries

X-ray measurements

Treatment

Goal : restore function to the level before

the insult
Restoring the original anatomy
Closed treatment not recommended
except displacement is within acceptable
limits.
Open treatment restore the anatomy to
its original condition without forced
manipulations

Treatment
Non-operative
Extra articular fracture of the tibia and
fibula
Non displaced fracture
Short leg cast for 4 6 weeks

Treatment
Operative
Unstable fracture
Internal fixation all fracture of the
articular surface with displacement
greater than 2mm lateral or posterior at
the lateral or medial malleolus

Post-operative Care

Prevent the foot from dropping into

equinus
Elevate the limb until swelling subside
Gentle ROM exercise can begin as
tolerated
limited weight bearing for at least 6
weeks

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