Ankle Fractures

Weber Classification
Type A: Avulsion fracture of the fibula below the level of syndesmosis
Type B: Oblique or spiral fracture of the fibula at or near the level of syndesmosis
Type C: Fracture of the fibula above the level of syndesmosis, with disruption of the
syndesmosis; often associated with medial malleolus fracture

Mechanism of Injury
Type I fracture due to inversion injury
Type II & III fractures due to external rotation forces.
Combinations of various forces give rise to various other fracture patterns

Examination
Haematoma and tenderness over fracture site
Check the skin condition and presence of distal pulses
X-rays
AD, lateral & mortise views

Management
Undisplaced Type I and Undisplaced stable Type II fractures. Bimall/Trimall fractures = unstable fractures.
Below knee backslab. NWB crutches ambulation. Analgesics.
TCU Ortho SOC 1/52
All other fracture patterns:
Below knee backslab. Admit to Ortho Dept for surgery

ANKLE SPRAINS
Mechanism of Injury
Majority are due to inversion injuries, spraining the lateral collateral ligaments
Examination
Tenderness +/- haematoma over the lateral collateral ligaments
Inversion of ankle is painful
Anterior drawer test.
X-rays
AP, Mortise and lateral views of ankle to exclude fracture and subluxation
Management
RICE : Rest, Ice, Compression (crepe bandage), Elevation
Home with analgesics and PWB crutches till pain resolved
Advice to seek further consultation if still unable to walk unaided after 5 - 7 days
TCU Ortho SOC 1/52 if clinically severe.

Herscovici Classification (Medial Malleolus Fracture)
A - tip avulsions (anterior colliculus)
B - intermediate
C - level of plafond
D - above plafond (adduction fractures)

Paper: conservative tx of isolated medial mall (http://www.bjj.boneandjoint.org.uk/content/89-B/1/89.full)
- Operative Mx: reserved for open #, bimall, trimall, injuries which compromise the skin or those involving the plafond, and for those patients who present with the development of painful nonunion

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more notes for ankle and foot fractures here: ankle # classifications, etc