January 18, 2012
July 21, 2013


Ankle Fracture: 1,2,3

Description:  Use Ottawa Ankle rules8, classificiations Danis-Weber’s, Lauge-Hansen, and Potts.  Fractures can involve lateral malleolus, posterior malleolus, medial malleoulus.
Weber’s Classification:
Type A – Distal Syndesmosis to Tib/Fib
Type B – From Tibial Plafond to Syndesmosis
Type C – Proximal to Syndesmosis
The following information is for stable isolated malleolar or distal fibular shaft fractures.
Diagnostic Imaging:   AP/Lat/mortise view (AP with 15 deg of adduction), and proximal tib/fiba to R/O maissoneuve fracture 1,2,3
Management:  U slab initially with foot in 90 degrees dorsiflexion. Then cast/Aircast walking boot with foot in 90 degrees dorsiflexion for 6-8 weeks, compression, ice 20-30 min q 2-4 hours, elevation.  NWB with crutches. ROM exercises after immobilisation. 1,2,3
Referral:  If Unstable (unilateral with ligament disruption on contrallateral side, bimalleolar, trimalleolar fractures), unsatisfactory reduction, disruption of the mortise.
F/U:  3-5 days for casting,  2 weeks re: symptoms, 4 weeks for xray check for union, if no union remain in immobilisation with xray q2weeks 3

Practical pearls:  Immobilisation, elevation and icing may be used prior to imaging to decrease patient’s discomfort.  Avoid common pitfalls by assessing neurovascular status prior to and post management.  Be aware of limits to radiological investigations, and have a high index of suspicion if patient still symptomatic despite “normal” Xrays.   When the history provides an inadequate mechanisms of injury to account for extent of injury consider abuse and bone tumours.  And finally if pain and dysfunction are not in keeping with injury also consider neurovascular injury, compartment.

Dr. Neil Dilworth ( Feb 27, 2012)


1.  Birrer RB, Kalb RL Field Guide to Fracture ManagementLippincott Williams & Wilkins  1st Ed. 2009.

2.  Eiff MP; Hatch RL; Calmbach WL; Higgins MK  Fracture management for primary care Philadelphia : Saunders, c2003. 2nd Ed.

3.  McRae R  Pocketbook of Orthopedics and Fractures  Elsevier, 2006. 2nd ed.