Ankle fractures


The ankle joint is formed by the connection of three bones. The ankle bone is called the talus. The top of the talus fits inside a socket that is formed by the lower end of the tibia (shinbone) and the fibula (the small bone of the lower leg). The bottom of the talus sits on the heelbone, called the calcaneus.

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Classification

There are many classifications for ankle fractures the most simple is the Danis-Weber classification: The fractures are classified according to location of the fracture and appearance of the fibular component.

Type A depicts a transverse fibular avulsion fracture, occasionally with an oblique fracture of the medial malleolus. These result from internal rotation and adduction.

Type B describes an oblique fracture of the lateral malleolus with or without rupture of the tibiofibular syndesmosis and medial injury (either medial malleolus fracture or deltoid rupture). These result from external rotation.

Type C designates a high fibular fracture with rupture of the tibiofibular ligament and transverse avulsion fracture of the medial malleolus. Usually syndesmotic injury is more extensive than in type B. These result from adduction or abduction with external rotation.

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Waber classification of ankle of ankle fractures

Management of ankle fractures.

The management of the fracture is governed by the stability of the fracture. Most of these fractures can be treated in a plaster that may be applied for 6-8 weeks 
The individual may be given crutches to encourage partial or non weigh bearing status for the first 3-4 weeks depending upon the fracture configuration. After the removal of the cast the patient may be referred to physiotherapy to help regain normal function.
If the fracture is not stable then surgery is undertaken and fixation of the fracture is then performed.

Recovery

Most patients will start to see improvement at around 3 months after the accident and then the fracture will show progressive improvement and typically by 6 months most patients have little daily concerns.

However recovery can continue up to 15-18 months post accident

Outcomes for ankle fractures

Van Der Sluis et al: Long-term physical, psychological and social consequences of a fractured-ankle. The long-term physical, psychological and social outcomes of 68 patients with an ankle fracture were investigated by using a postal questionnaire 6 years after injury. Eighty-nine per cent of the patients returned to work. Those with an ankle fracture needed 3 months to return to work.

Brown L et al Journal of orthopaedic trauma. 2001 May;15(4):271-4 Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures.
31 percent of the 126 patients had lateral pain overlying their fracture hardware. 23 percent had had their hardware removed or desired to have it removed. Of the twenty-two patients with hardware-related pain who had undergone hardware removal, only eleven had improvement in their lateral ankle pain

Lash N et al Ankle fractures: functional and lifestyle outcomes at 2 years.
Of 141 patients that sustained ankle fractures 5% achieved ‘poor’ results, 16% patients achieved a ‘fair’ result, 41% patients gained a ‘good’ result, 27 36% patients attained ‘excellent’ results.

Klossner “Late results of operative and non-operative treatment of severe ankle fractures” Acta Chir Scand Suppl. 293: 1-93, 1962
.  Incidence of osteoarthritis varies with severity of injury degenerative changes seen in 10% of anatomically fixed and in 85% if not adequately reduced – changes apparent within 18 months

Residual issues that may exist include stiffness of the ankle and women in particular may note difficulty wearing high healed shows.

Swelling 

Residual pain especially in association with cold