Ankle fractures are a common cause of admission to casualty. Clinical examination is facilitated by the

Ottawa ankle rules

to try and minimise the unnecessary use of x-rays.

These state that x-rays are only necessary if there is pain in the malleolar zone and:

• 1. Inability to weight bear for 4 steps
• 2. Tenderness over the distal tibia
• 3. Bone tenderness over the distal fibula

Weber classification

Related to the level of the fibular fracture.

• Type A is below the syndesmosis
• Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
• Type C is above the syndesmosis which may itself be damaged

A subtype known as a Maisonneuve fracture - may occur with spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required.

Management

Depends upon stability of ankle joint and patient co-morbidities.

• All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis
• Young patients, with unstable, high velocity or proximal injuries will usually require surgical repair. Often using a compression plate.