ANKLE FRACTURES & DISLOCATIONS

Introduction
 The ankle joint itself is limited to one plane of motion: plantarflexion and dorsiflexion in the
sagittal plane
 The syndesmotic ligament connects the tibia to the fibula at the level of the tibial plafond
 Fracture-dislocations of the ankle are frequently referred to as bimalleolar (fractures of the
medial and lateral malleoli) or trimalleolar (fractures of the medial, lateral, and posterior
malleoli).

Classification
 Presently, the two most widely used classification schemes for describing ankle fractures are
the Lauge-Hansen and Weber classifications.

The Weber classification

 It is based on the level at which the fibular fracture occurs.

A. Type A: Fracture in which the fibula is avulsed distal to the joint line.
I. Isolated fracture
II. Fracture fibula & medial malleolus
III. Fracture posterior, lateral and tibia
B. Type B: Spiral fracture of the fibula beginning at the level of the joint line and extending in
a proximal-posterior direction up the shaft of the fibula.
I. Isolated syndesmosis fracture
II. Fracture lateral & medial malleolus
III. Fracture medial & posterolateral tibia
C. Type C: Fracture of the fibula proximal to the syndesmotic ligament complex, with
consequent disruption of the syndesmosis.
I. Isolated
II. Communited fibula fracture
III. Fracture proximal fibula
or
 Based on location of fibula fracture relative to mortise.
A. Weber A fibula distal to mortise
B. Weber B fibula at level of mortise
C. Weber C fibula proximal to mortise
 Concept - the higher the fibula the more severe the injury

Treatment
 Initial treatment of ankle fractures should include immediate closed reduction and splinting
 If the fracture is open, the patient should be given appropriate intravenous antibiotics and
taken to the operating room on an emergent basis for irrigation and debridement of the
wound, fracture site, and ankle joint.

Nonoperative Treatment
Indications:
 Nondisplaced stable fracture with intact syndesmosis
 Patient whose overall condition is unstable and would not tolerate an operative procedure

Management:
 Below the knee cast for 4-6 weeks
 Follow with serial x-rays and transition to walking boot or short-leg walking cast

Surgical Indications
 Instability: Talar subluxation
 Malposition: Joint incongruity and Articular stepoff