ABSTRACT
CONTENTS I. Introduction ...................................................................................................................... 1 II. Anatomy............................................................................................................................ 2 III. Classification of Ankle Fractures ...................................................................................... 4 IV. Physical Examination ........................................................................................................ 5 V. Radiographic Examination................................................................................................ 6 VI. Outcome of Ankle Fractures ............................................................................................. 7 VII. Comparison of Operative and Nonoperative Results ........................................................ 8 VIII. Results of Operative Intervention...................................................................................... 9 IX. Historical and Research Considerations for Treatment of Ankle Fracture Subtypes:
A Brief Review .................................................................................................................. 9
A. Isolated Lateral Malleolus ......................................................................................... 9
B. Posterior Malleolar Fracture ................................................................................... 10
C. Medial Malleolar Fracture....................................................................................... 11
D. Syndesmosis Involvement ........................................................................................ 11
E. Talar Shift without Fracture .................................................................................... 12
F. Osteochondral Injury ............................................................................................... 12
G. Open Fractures ........................................................................................................ 12
H. Techniques of Closed Reduction and Subsequent Care........................................... 13 X. Surgical Techniques ......................................................................................................... 13
A. Lateral Malleolus ..................................................................................................... 13
B. Medial Malleolus ..................................................................................................... 14
C. Bimalleolar............................................................................................................... 15
D. Trimalleolar ............................................................................................................. 19 XI. Osteoporosis and Ankle Fractures .................................................................................. 19 XII. Ankle Dislocation or Ligamentous Disruption ............................................................... 21 XIII. Conclusion....................................................................................................................... 23 References ................................................................................................................................... 23
I. INTRODUCTION
The ankle is among the most frequently injured joints. While most of these injuries are sprains and soft tissue disruption, ankle fractures are common and involve a very intricate joint. Fractures about the ankle are reported in ancient texts dating thousands of years, and a common theme is an
appreciation for the complexity of this seemingly trivial injury. Even today, some think of these injuries as the ‘‘junior resident’s case’’ when, in fact, the decision making is complex and the results — on close inspection — are not as universally good as previously thought. The ankle suffers fools poorly, malreduction can often progress quickly to end-stage degenerative joint disease. Treatment depends on understanding the anatomy, consideration of the soft tissues, and sound surgical principles. The orthopedic guidelines are now well established: rigid internal fixation may allow early range of motion. This chapter is written to elucidate these issues and warn of pitfalls along the path of optimal fracture care.
