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Stability in ankle fractures: Diagnosis and treatment

Many classifications have been proposed to describe these fractures, based either on the anatomy of the fracture or the mechanism of injury. The Danis-Weber (1966) classification is still widely used, probably because it is simple. It is based on the level of the fibular fracture in relation to the distal tibiofibular syndesmosis, distinguishing between types A, B, C where the fracture is below, at, or above the syndesmosis. It was developed on the basis that the lateral column plays the major role in the treatment of ankle fractures and that the higher the fibular fracture, the higher the chance of instability. Although the second is partially true, the classification does not describe the…

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 Danis-Weber Classification of Ankle Fractures

The Danis-Weber classification (Weber classification) is a simple method for classifying fractures of lateral ankle fractures and is based on radiographic criteria. It takes into consideration the position of the distal fibular fracture in relation to the syndesmosis of the ankle joint. There are three classifications based on the location and type of fracture.

 The Quigley Maneuver for Ankle Fractures

A modified single-person Quigley maneuver can be done in two ways. The first technique involves the provider bending the patient's knee and dorsiflexing the foot by pulling on the toe, internally rotating the foot and externally rotating the lower leg. This is also shown in the video below. You can also place a stockinette over the injured leg and hang the foot in traction using an IV pole or weighted stand. This negates the need for a second person, although a nurse or technician can help with this maneuver, and it should rarely have to be done alone.

Articles of Interest

Ankle Fractures: Not As Simple As Most Think!

There are many different types of ankle fractures. Some you can walk on immediately in a boot and do not require surgery and some require surgery to avoid long term problems. Determining whether an ankle fracture requires surgery is a complex process and frequently requires advanced imaging such as a CT scan.

Acute Management of Trimalleolar Fracture

Trimalleolar fractures are unstable and thus almost always will require surgical repair. This is true even for elderly patients and those with co-morbidities.

Adult Ankle Fractures (ankle and foot soft tissue injuries and fractures)

Ankle fractures account for 9.3% of all fractures, over 50% of traumatic foot and ankle fractures, and are the 4th most common fracture in the elderly.

Ankle Fractures

Utilize the Ottawa Ankle Rule to minimize the amount of X-rays performed. It is imperative to perform a good physical exam and to acquire the appropriate imaging to capture fractures that may easily be missed. Associated dislocations should be reduced and anatomic alignment should be achieved prior to immobilization.

CORE EM: Ankle Stress Views: Why, When + What

So if you see an isolated lateral malleolar fracture on x-ray, it could be a stable fracture (not much more than an ankle sprain) or an unstable injury that requires a cast and an orthopedist. How can you tell the difference? Enter the Stress View.

Paucis Verbis card: Ankle fractures

Ankle fractures are a common injury diagnosed in the Emergency Department. Being able to speak Ortho-ese (i.e. the language of orthopedists) is invaluable in consulting the orthopedist over the phone. One ankle fracture classification system that our orthopedists like to use is the Lauge-Hansen system.

Pilon Fractures of the Ankle

A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from a height. Pilon fractures are often severe injuries that can permanently affect the ankle joint.

Principles and guidelines in the management of ankle fractures in adults

Ankle fractures can be classified using the Danis–Weber classification system. Type A fractures involve the lateral malleolus distal to the tibiofibular syndesmosis. They are usually stable and are managed conservatively.

Radiographic analysis of adult ankle fractures using combined Danis-Weber and Lauge-Hansen classification systems

There are several types of classification for ankle fractures. Ankle fractures were firstly classified as unimalleolar, bimalleolar or trimalleolar5,9. However, this classification does not distinguish unstable and stable injuries even though it is intuitive and easy to reproduce. Through cadaver experiments, Lauge-Hansen suggested a classification system which correlates the lines of ankle fractures with specific traumatic mechanisms10, with the fractures being classified into four groups: supination-adduction, supination-external rotation, pronation-external rotation, and pronation-abduction.

Too Bad: Bi-mal Ankle Fractures

Ankle fractures have a variety of classification systems based on foot position and force, anatomy, and location of fracture. A bimalleolar fracture involves both the medial and lateral malleoli; a bimalleolar equivalent fracture involves the lateral malleolus, but there is also an associated deltoid ligament tear that results in lateral displacement of the talus...

Resources

Maimonides Emergency Medicine

Many classifications are available but for ED we can use Closed Ring System.

Orthopaedia

Ankle fractures are breaks of the distal tibia or fibula (near or in the so-called malleolus) affecting the tibiotalar (ankle) joint. Occasionally, they involve the shaft of the fibula as well. Ankle fractures range from simple injuries of a single bone to complex ones involving multiple bones and ligaments. Twisting with the foot planted on the ground and the body rotating around it is the most common mechanism of injury.

Physiopedia

Ankle fractures are most commonly diagnosed through clinical examination and x-ray. Ottawa rules provide clinicians with a tool to decide whether the joint should be imaged or not. Several classifications exist and are used to determine the severity of injury and management. Examples include the Danis-Weber classification which identifies the level of injury and; the Lauge-Hansen classification which is based on the mechanism of the injury which have predictable patterns and imaging findings.

StatPearls

About 187 per 100000 adults sustain ankle fractures every year The highest incidence in the female population is between 75 and 84 years old, compared to 15 to 24 years old for males.[8] Isolated uni malleolar fractures are the most common type accounting for 70% of the yearly incidence of all ankle fractures. About 20 % of ankle fractures are bimalleolar fractures, while trimalleolar fractures represent about 7% of all ankle fractures. Open ankle fractures incidence is about 2% of all ankle fractures.