//fpnotebook.com/
Ankle Fracture
Aka: Ankle Fracture, Ankle Fracture Weber Classification, Bimalleolar Fracture, Trimalleolar Fracture, Tibia-Fibula Fracture, Tib-Fib Fracture, Weber A Fracture, Weber B Fracture, Weber C Fracture- Epidemiology
- Ankle Fractures account for 15% of acute ankle injuries
- Classification: Weber
- Weber A (stable)
- Weber B (may be unstable)
- Fracture at the level of the talar dome
- Oblique fibula Fracture (spiral Fracture) at syndesmosis
- May be accompanied by medial deltoid ligament tear or medial malleolus transverse avulsion Fracture
- May tear anterior tibiofibular ligament (lateral ankle)
- Syndesmosis is typically intact, but Fracture is often unstable (esp. if medial Deltoid ligament rupture)
- Weber C (unstable)
- Lateral malleolus fibula Fracture, above ATF ligament
- Associated with Tibiofibular syndesmotic ligament rupture
- May be associated with transverse medial malleolus Fracture or medial Deltoid ligament rupture
- Images
- References
- Exam
- See Ankle Exam
- See Knee Exam
- See Foot Exam
- Differential Diagnosis
- Signs and Symptoms
- Pain
- Swelling
- Inability to bear weight
- Significant deformity if dislocation present
- Associated Conditions
- Fifth Metatarsal Fracture
- Maisonneuve Fracture (Proximal Fibula Fracture, rotational injury)
- Associated with Compartment Syndrome
- Lateral Talus Fracture
- CT ankle indicated for significant swelling at lateral talus despite negative xray
- Imaging
- Ankle XRay
- See Ankle XRay (consider xrays of foot and tibia-fibula)
- Instability findings
- Widening of ankle mortise (Weber C and some Weber B Fractures)
- Consistent with unstable Ankle Fracture
- Lateral talus displacement on gravity stress or external rotation (Weber B)
- Suggests Deltoid ligament rupture (and unstable Fracture)
- Widening of ankle mortise (Weber C and some Weber B Fractures)
- MRI foot indications
- Suspected Calcaneal Stress Fracture or Navicular Stress Fracture
- Ankle XRay
- Management: Initial emergency department evaluation
- General measures
- RICE-M Therapy
- Reduce Ankle Fracture-dislocation
- Emergent orthopedic evaluation and surgery
- Routine surgical management
- Indications
- Weber C Fracture
- Weber A Fracture with medial malleolus Fracture
- Trimalleolar Fracture
- Maisonneuve Fracture
- Weber B Fracture with instability (refer all Weber B Fractures to orthopedics for reevaluation)
- Findings suggestive of instability
- Ankle mortise wide
- Lateral talus displacement on gravity stress or external rotation
- Findings suggestive of stability (stable Fracture in 98% of cases if both criteria present)
- Posterior displacement of of distal Fracture fragment <2mm (on lateral XRay)
- Only two Fracture fragments
- Nortunen (2017) J Bone Joint Surg Am 99(6): 482-7 +PMID:28291180 [PubMed]
- Findings suggestive of instability
- Initial management
- Immobilize in fiberglass or plaster splint (sugar tong with or without posterior splint)
- Non-weight bearing
- Follow-up re-evaluation orthopedics for possible surgical management
- Weber B Fractures are indeterminate for surgical management until Stress Imaging
- ORIF may be performed in first day prior significant swelling, but otherwise after 6 days
- Indications
- Conservative Management
- Weber A Fracture without medial medial malleolus Fracture
- CAM Boot or hard-soled shoe
- Weight bearing as tolerated
- Fracture line may persist on xray despite asymptomatic patient (no management required)
- Distal fibular chip Fracture (ATF or CF Ligament avulsion Fracture)
- Treat with Ankle Sprain Management
- Weber A Fracture without medial medial malleolus Fracture
- General measures
- Management: Weber-based protocol
- Surgical management (ORIF) Indications (disrupted ankle mortise)
- Non-surgical, conservate management
- Weber B Fracture with stable ankle mortise
- Weber A Fracture (stable Fracture)
- Complications
- Ankle Osteoarthritis
- Likely if poorly aligned ankle mortise or talus position
- Fracture management shoul ensure smooth articular surface of ankle
- Ankle Osteoarthritis
- Prognosis
- Stable Fractures treated with non-operative, conservative therapy
- Return to baseline activity within 6-8 weeks is common
- Unstable Fractures requiring surgical intervention
- Weight bearing after surgery is often delayed up to 12-16 weeks
- Return to full functional capacity may require up to 2 years
- References
- Stable Fractures treated with non-operative, conservative therapy
- References
- Courtney and Shannon (2020) Crit Dec Emerg Med 34(5): 14-5
- Orman and Ramadorai in Herbert (2017) EM:Rap 17(1): 7-9