Pakarinen HJ, Flinkkil TE, Ohtonen PP, Ristiniemi JY. Ankle fractures occur in people of all ages and are among the most common injuries treated by an orthopaedic surgeon. During the treatment and follow-up period, the mean total number of radiographs performed for non-surgically treated patients were 2.2, compared with 2.9 in the surgically treated group. The Danis-Weber classification grades the ankle fracture based on the location of distal fibular fracture as compared to the syndesmosis.3 A Danis-Weber Type A is a fracture of the lateral malleolus distal to the syndesmosis and is usually stable unless there is also a medial malleolar fracture. Ankle fractures are common emergency department presentations, with an incidence of 187 per 100,000.1 Not surprisingly, there is a bimodal distribution with a peak during the years of 15-24, particularly in males, and then again between the ages 75 and above, when falls become more prominent, and osteoporosis sets in, particularly in women.1,2. 4). Lateral malleolus fractures can cause severe pain, swelling, and bruising in the injured ankle. Stress fractures often don't show up on X-rays until the break actually starts healing. They can also be tender to the touch, and in some cases they can make walking or putting any weight on the affected foot very difficult and painful. When they do occur, they are usually part of a more complex pattern of ankle fractures. For best healing, it is important to follow instructions from your surgeon regarding your post-operative care. Wennergren D, Stjernstrom S, Moller M, Sundfeldt M, Ekholm C. Validity of humerus fracture classification in the Swedish fracture register. Doctors classify ankle fractures according to the area of the bone that is broken. 2016;47(2):47882. A Danis-Weber Type B is a fracture at the level of the syndesmosis and has variable stability. When 2 malleoli are fractured, the injury is called a bimalleolar ankle fracture and when 3 malleoli are fractured, the injury is called a trimalleolar ankle fracture. The most commonly affected age group was 5665years. 2023 BioMed Central Ltd unless otherwise stated. CAS These fractures are stable and typically do not require surgery. Ankle stability is maintained by ligamentous and bony anatomy. This is when a gap appears in the bone at the site of the fracture and these often require surgical repair, This is a type of fracture involving the growth plate and is common in children. Primary and late results of operative and non-operative treatment. Review the latest information on visitor policies, safety procedures, vaccines, and more in the COVID-19 Resource Center. DW planned and conducted the study, analysed data and revised the manuscript. Acta Orthop. Pakarinen HJ et al. This complication can occur with or without surgery, and you should discuss this with your surgeon to determine your treatment options. Other bones around the ankle joint can be injured as well, but an ankle fracture usually involves the bones of the tibia and fibula. The .gov means its official. The talus is a small bone that sits on top of the heel bone, and it forms the lower part of the ankle joint. It can involve the ligaments attaching to the fibula and can be stable or unstable. HHS Vulnerability Disclosure, Help Weber B fractures are generally stable fractures that can be managed conservatively with immobilisation and physical therapy. This is usually followed by imaging to rule out other conditions and to confirm the diagnosis. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Rehabilitation exercises are similar to that of a sprained ankle. All rights reserved. In younger patients, your doctor may recommend removal of the hardware, fusion, or other surgery. Lateral malleolar fractures at the level of the syndesmosis, AO/OTA 44 B fractures, are the fourth most common fracture registered in the SFR and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries [ 8, 9] (Fig. This probably reflects a lack of understanding of the classification of ankle fractures. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Epub 2018 Apr 19. The main ligament is the deltoid ligament. Stenquist DS, Miller C, Velasco B, Cronin P, Kwon JY. It is called a lateral (outside of the ankle) malleolus fracture and is depicted in Figure 5. Like the original injury, surgery produces swelling and swelling can put tension on your wounds. A clinical interview of your symptoms alongside a clinical examination can often be sufficient to achieve a diagnosis for your therapist. The medical records of the patients that had initially been assigned to non-surgical treatment but had been changed to surgical treatment at an early stage were additionally studied to ascertain why the treatment strategy had been changed. eCollection 2022 Oct. Frederiksen JO, Malmberg C, Karimi D, Tengberg PT, Troelsen A, Terndrup M. J Orthop Surg Res. Arbeitsgemeinschaft fr Osteosynthesefragen. Rydberg, E.M., Zorko, T., Sundfeldt, M. et al. The Ottawa ankle rules recommend radiography if there is bony tenderness along the posterior edge of fibula or tip of the lateral or medial malleolus, at the base of the 5th metatarsal bone, at the navicular bone, or if there is inability to bear weight both immediately after injury and for 4 steps during initial evaluation.6 In our patients case, radiography was warranted as she could not bear weight and also had tenderness along the posterior edge of the lateral malleolus. Broken Ankle? 2009;91(5):10429. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 8600 Rockville Pike The Swedish Fracture Register (SFR) is a national quality register that collects data on all types of fracture regarding cause of injury, type of fracture, given treatment, and subsequent treatment results [1]. Emergency Medicine Correspondence to Diagnosis is made with plain radiographs of the ankle. University of Central Florida College of Medicine, Orlando Florida, USA; HCA Florida Ocala Hospital, Ocala, Florida, USA. Each fracture will require a specific repair procedure during the surgery. In some cases, though, surgery has to be performed to align the bone and hold it together with metal plates, rods, or screws. Springer Nature. Your feedback has been submitted successfully. 1). The knob on the outside of the ankle, the lateral malleolus, is the end of the fibula, the smaller bone in the lower leg. Fibula fractures occur around the ankle, knee, and middle of the leg. The most common cause of injury was a fall on the same level due to slipping, tipping or stumbling (47%) for all ankle fractures, as well as for all subtypes respectively. For unstable Lateral Malleolus Fractures or a malunion, surgery may be required. Twoyears were studied and the results are not affected by seasonal variations. Jain N, Symes T, Doorgakant A, Dawson M. Clinical audit of the management of stable ankle fractures. This results in a small, often unstable fragment. When this part of the bone fractures, or breaks, it's called a lateral malleolar fracture. All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts. Summary. 1995;39(6):111922. In general, it takes at least 6 weeks for the broken malleolus to heal. Kennedy JG, Johnson SM, Collins AL, et al. A lateral malleolus fracture can be treated with self-care through rest, elevation, ice application and anti-inflammatory medications. The deep deltoid ligament is considered the primary stabilizer of the ankle. Injury. Appointments 216.444.2606 Unauthorized use of these marks is strictly prohibited. The picture in Figure 4 shows a patient with a fractured ankle that is dislocated and pushing against (tenting) the skin. 2015;16:338. 7. 2023 Johns Hopkins All Childrens Hospital. 18% (n=24) of the surgically treated patients were found to have no medial tenderness. Upon removal of the boot, rehabilitation can last for 4-6 weeks. There was no tenderness to the base of the 5th metatarsal, or over the fibular head. In the case that clinical/radiographic findings are indicative of ankle instability, surgical fixation options include lateral or posterolateral plating or intramedullary fixation. The surgery for a trimalleolar ankle fracture is a combination of the three surgeries that are done when each bone breaks individually. In the study population comprising all ankle fractures, the median age was 55years (1698) and the men had a mean age of 47years and the women 57years. Rosemont, IL 60018-4975, Phone: (847) 698-1631 The guidelines for diagnosis and management were adopted from the work done by Wykes et al. 2016 Jul;47(7):1581-5. doi: 10.1016/j.injury.2016.03.017. Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures. Patients with a lateral malleolus fracture may also experience swelling, bruising and pain on firmly touching the affected region of bone. 2017. Please consider using one of these supported browsers. OTA SOMOS Military Traveling Fellowship Program, IOTA Special Issue: Orthopaedic Trauma Care: Global Approaches During a Pandemic, Research Volunteer Mentoring Program Overview, OTA Support of Federal Grant Applications, CNTR Early-Stage Investigator Travel Award Application, The Issue of the Surprise-Billing Rules in Plain English, Disaster Management and Emergency Preparedness, Disaster Management and Emergency Preparedness Overview, OTA Orthopaedic Trauma References & Resources, Lifetime & Planned Giving Donors Overview, Corporate & Foundation Donor Archive Overview, Exhibits & Marketing Partnerships Overview, Sponsorship Right of First Refusal Guidelines, Video Library: Annual Meeting & Conferences, Evidence-Based Medicine Resource List Overview, American Orthopaedic Foot & Ankle Society. MECHANISM OF LATERAL MALLEOLUS FRACTURE. Locking plates and small or minifragment fixation are important adjuncts for the surgeon to consider based on individual patient needs. pop sound at the time of injury; a swollen, tender area on the outside (lateral) ankle It is called a lateral (outside of the ankle) malleolus fracture and is depicted in Figure 5. Stretching and strengthening exercises supervised by a doctor or physical therapist can help improve ankle function and mobility during the healing process. Fracture and dislocation classification compendium - 2007: Orthopaedic trauma association classification, database and outcomes committee. A Danis-Weber Type C fracture is always unstable and occurs proximal to the level of the syndesmosis. 91 Topic Podcast Images Summary Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. Among the surgically treated patients 18% (n=24) were found to have no medial tenderness. In addition to the postoperative immobilization in a cast, 79% of the surgically treated patients and 50% of the non-surgically treated patients had some kind of weight-bearing restriction. According to the AO/OTA classification, a trans-syndesmotic fracture of the lateral malleolus, combined with a rupture of the medial ligament, is a 44B2 fracture. You may be instructed in home exercises at this point, and given a fracture boot to allow easy removal for bathing and range of motion exercises. At the time of the study there were no strict guidelines at the department regarding which fractures to treat surgically and which to treat non-surgically. When a child twists their ankle, the medial malleolus can fracture. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients and in 77 (25%) there was no comment on medial tenderness in the medical charts. All x-rays and pictures taken from the personal collections of Dr. Shafiq and Christopher Domes, MD, Orthopaedic Trauma Association9400 W. Higgins Road, Suite 305 Careers, Unable to load your collection due to an error. The worse the injury, the more likely it will be unstable. Among the 439 patients in the current study classified as having sustained an AO/OTA 44B1 fracture, 31% presented with medial tenderness at the physical examination. We believe that an algorithm that allows early weight-bearing would reduce patient suffering and allow for an earlier return to physical activity and work, beneficial both for the individual and for society. May be associated with a dislocation of the ankle joint. Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture. Careers. 2022 Dec 8;7(4):24730114221141388. doi: 10.1177/24730114221141388. Arch Surg (Chicago, Ill : 1920). Negative prognostic factors in surgical treatment for trimalleolar fractures. Appointments & Locations. 5. Isolated lateral malleolus fractures are the most common fracture involving the ankle. On the other hand, if a stable isolated lateral malleolar fracture with no medial injury is correctly classified as B1 and still undergoes surgical treatment, it is probably exposed to unnecessary surgical treatment and the risks that entails. 2009;129(2):22735. Graded exposure to impact activities and return to play protocols if you wish to return to sport. Stretching and strengthening exercises supervised by a doctor or physical therapist can help improve ankle function and mobility during the healing process. Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Emilia Mller Rydberg,Tina Zorko,Michael Mller&David Wennergren, Department of Orthopaedics, Sahlgrenska University Hospital, Gteborgsvgen 31, SE-431 80, Gothenburg/Mlndal, Sweden, Emilia Mller Rydberg,Mikael Sundfeldt,Michael Mller&David Wennergren, You can also search for this author in She was discharged from the ED with orthopedics follow up within 48 hours. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. The average number of days of immobilization in a plaster or a brace were 46 for the surgically treated patients compared with 43days for non-surgically treated patients. The Miller School of Medicine, University of Miami, Miami, Florida, USA, 3 Accessibility To best describe the degree of injury, we describe ankle fractures according to the number of malleoli fractured. 1. MM planned and conducted the study and revised the manuscript. Wennergren D, Ekholm C, Sandelin A, Moller M. The Swedish fracture register: 103,000 fractures registered. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment. X-rays of the patients left ankle revealed a transverse fracture of the lateral malleolus (Figure 1). 2020 Jun;51(6):1392-1396. doi: 10.1016/j.injury.2020.03.029. These fractures are often caused by traumatic events such as falls or trips, but can also result from overuse injuries or poor biomechanics. More than 80% were clinically healed after 4weeks and no patients with secondary displacement were found. Stability criteria for nonoperative ankle fracture management. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. RWP has been a member of the Dutch Orthopedic Association Committee, has received grants for the ZonMW ESCAPE trial, DART trial, Achmea Escape trial and Van Rens Fonds REDEP trial, and has contributed to the following educational events: the Waldemar Link hip course and the J&J hip course. The patient also endorsed that the pain worsened with palpation and improved with rest. 2. For identified AO/OTA44-B1 fractures, medical records and radiographs were reviewed and analyzed. van den Bekerom MP, Mutsaerts EL, van Dijk CN. Management of Isolated Lateral Malleolus Fractures. However, since this is Swedens largest orthopedic center, with a primary catchment area of approximately 600,000 inhabitants, we believe that it is representative of the population of Sweden. Knutsson SB, Wennergren D, Bojan A, Ekelund J, Moller M. Femoral fracture classification in the Swedish fracture Register - a validity study. Please enable it to take advantage of the complete set of features! Terms and Conditions, A study 47 lateral malleolar fractures showed plain radiography sensitivity to be 92.8%, with a specificity of 100% compared to a sensitivity of 100% and a specificity of 93% for ultrasonography.7. A focused physical examination showed tenderness and edema near over the posterior edge of left lateral malleolus. Acta Orthop Scand. Please note the date of last review or update on all articles. A severely broken foot may require surgery to implant plates, rods or screws into the broken bone to maintain proper position during healing. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. MeSH A study of 123 patients with lateral and mortise x-ray views are 95% accurate in diagnosing ankle fractures as anteroposterior, lateral and mortise views. Despite the fact that its been shown that medial tenderness, brusing or ecchymosis are unreliable predictors of medial ligament injury these are the signs used in clinical practice today. As such, your doctor will determine the best timing for surgery and the best location for skin incisions to minimize your risk. As a library, NLM provides access to scientific literature. The current study demonstrates the difficulty involved in distinguishing whether or not a trans-syndesmotic lateral malleolar fracture has an associated medial ligament injury or not. Signs and Symptoms. The most common malleolus fracture happens at the fibula. When surgeons think about ankle fractures, we think in terms of these bony parts and ligaments. A lateral malleolus fracture usually requires the personto keep weight off the affected foot for a few weeks. Injury. Center for Medical Simulation & Innovative Education, Cores, Shared Resources & Support Offices, Institute for Clinical and Translational Research, Institute for Fundamental Biomedical Research. This type of fracture can be caused by twisting of the foot and ankle, a trip or fall, or a direct blow to the ankle. E-mail: OTA@ota.org. Epidemiology of ankle fractures in Rochester, Minnesota. It would also minimize the number of radiographs per patient, reducing both costs and unnecessary risks. In most cases, people return to normal daily activities within 3 to 4 months. By repairing the ankle surgically, we can confidently allow early range of motion exercises to reduce stiffness and disability that can result from prolonged treatment with a cast or splint. BMC Musculoskeletal Disorders PDF | On Aug 2, 2022, Mohammad Ayati Firoozabadi published Novel Fixation Method (Tension Band Wiring Over the One-Third Tubular Plate) for Displaced Lateral Malleolar Tip Fracture - Preliminary . Among the patients registered in the SFR as having sustained a B1 fracture, the sex distribution was 47% men and 53% women. Kohake MBJ, Wiebking U, OLoughlin PF, Krettek C, Gaulke R. Mid- to Long-term Outcomes After Weber B-type Ankle Fractures With and Without Syndesmotic Rupture. If the broken bone is not out of place and the ankle is stable, treatment may consist of just wearing a special boot or cast to immobilize the ankle as it heals. 2019;20(1):197. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Of the patients with C2 fractures, 75% were women and their mean age was 57years, whereas the men in the same group had a mean age of 38years (Table 1). If surgery is needed, it is commonly done within 5 to 10 days, but may be delayed up to 3 weeks in some cases if your ankle is too swollen. The bony parts of the fibula and tibia are called malleoli (singular = malleolus). Ozturk P, Aksay E, Oray NC, Bayram B, Basci O, Tokgoz D. Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture. This is because there is very little tissue (fat, muscle, fascia) between the skin and the bone around the ankle. Stability of the ankle mortise is determined by bony components (fibula, tibia and talus) and ligamentous structures (syndesmosis complex and lateral and medial collateral ligaments). If fixed surgically on the lateral side, a potentially unstable B fracture is transformed to a stable fracture and, in the authors opinion, should be allowed full weight-bearing postoperatively. Ankle fractures: supination-eversion fractures of stage IV. Compatibility of Lauge-Hansen Classification Between Plain Radiographs and Magnetic Resonance Imaging in Ankle Fractures. Clinical examination findings are important but less reliable. The medial malleolus may be fractured or deltoid ligament may be torn. Displaced fractures are commonly treated with an open reduction and internal fixation. Accessibility government site. 1980;51(6):98190. May also be called: Lateral Malleolar Fracture. A lateral malleolus fracture is a type of ankle fracture that occurs when the fibula fractures just above the ankle joint. 27% of all B1 fractures (73% of the surgically treated and 8% of the non-surgically treated) were admitted to hospital. Fractures can range from tiny cracks in your bones to breaks that pierce your skin. This pattern was also seen for most of the individual fracture classes with the exception of the groups of A3 and C3 fractures where there were substantially more men than women (A3 men: women 65:35 and C3 men: women 76:24) (Table1). Fractures of the medial malleolus are relatively uncommon. 2018 Jul-Aug;57(4):712-715. doi: 10.1053/j.jfas.2017.12.009. Clinical signs like medial tenderness, ecchymosis and swelling are commonly considered, as well as tests for stability like the external rotation test [17] or stress gravity radiographs [18]. After surgery, you will most likely be in a plaster splint or fracture boot. 2022 May 3;17(1):252. doi: 10.1186/s13018-022-03135-z. Bethesda, MD 20894, Web Policies In SFR ankle fractures are classified according to the Arbeitsgemeinschaft fr Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification [15, 16] (Fig. Lateral malleolus fractures cause pain, swelling, and bruising around the ankle. While most ankle fractures heal well, some may develop post-traumatic arthritis, with increasing pain and stiffness. The main bones are the tibia, fibula, calcaneus and cuboid. Northwestern Medicine is a trademark of Northwestern Memorial HealthCare, used by Northwestern University. Most often, the emergency room doctor will examine your foot and ankle for sensation, blood flow, and your ability to move your toes. Symptoms of a Lateral Malleolus Fracture include swelling and bruising over the lateral ankle, pain on weight-bearing, walking or hopping, pain when walking on uneven surfaces, and a protruding bone or malaligned foot in severe cases. The dorsalis pedis pulse was intact, and there were no open wounds. If you have pain in other areas of the foot and ankle, you may have a more serious ankle injury. A Combination of Ilizarov Frame, Externalized Locking Plate and Tibia Bridging for an Adult with Large Tibial Defect and Severe Varus Deformity Due to Chronic Osteomyelitis in Childhood: A Case Report. Treatment for broken ankles depends on the fracture. If the broken bone is not out of place and the ankle is stable, treatment may consist of just wearing a special boot or cast to immobilize the ankle as it heals. J Orthop Trauma. Minimizing that tension can help reduce the risk of infection and also helps with pain. Inclusion in an NLM database does not imply endorsement of, or agreement with, Babar Shafiq, MD 3). Google Scholar. Each of these bones has critical parts that work to hold the ankle together while still allowing motion. An evaluation of the Weber classification of ankle fractures. In some cases, though, surgery has to be performed to align the bone and hold it together with metal plates, rods, or screws. 96% of the fractures were due to low-energy trauma and 99% were closed injuries. Lateral malleolus the prominent bone on the outer side of the ankle at the end of the fibula The ankle joint allows you to bend your foot up and down and to move it from side to side. The patient was unable to ambulate. 7. A bone scan can help your doctor diagnose fractures that don't show up on X-rays. studied the epidemiology of ankle fractures in Sweden between 1987 and 2004 but there is a lack of up to date epidemiological studies on ankle fractures [7]. Michelson et al. During the 2 consecutive years from 1 April 2012 and 31 March 2014, 1328 patients with ankle fractures were treated at SU. One limitation in the current study is, however, the lack of a long-term follow up, most importantly for the non-surgically treated B1 fractures with medial tenderness with respect to displacement and a subsequent need for surgery. Injury. These types include: lateral malleolus . The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1week. In addition, 2 of the non-surgically treated patients were treated surgically at a later stage due to non-union. A 35 year old female presented to the emergency department (ED) via emergency medical services (EMS) with left ankle injury and swelling at the injury site. You should not bear weight on your foot during this early, critical phase of healing. As shown in Table1, 27% of the ankle fractures were infra-syndesmotic type A fractures, 63% were trans-syndesmotic type B fractures and 11% were supra-syndesmotic type C fractures. and demonstrated by Jain N et al., significant financial savings can be attained if patients treated non-surgically do not have to undergo follow-up radiographic examination and are subject to fewer outpatient visits. Google Scholar. At our department all non-surgically treated B1 fractures are followed up at 1week with a radiographic examination. If you suspect you have a Lateral Malleolus Fracture, seek medical attention promptly to avoid further damage and ensure the best possible outcome. 1. Appointments 216.444.2606. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. A broken ankle is a fracture or multiple fractures of one or more of three bones in the ankle joint: the tibia (shinbone), the fibula (outer bone of the lower leg), and the talus. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone. In the current study the presence or absence of medial tenderness did not appear to be the deciding factor in the choice between surgical or non-surgical treatment, possibly due to the difficulty involved in evaluating clinically if a medial ligament injury is to be suspected or not. 2023 Johns Hopkins All Childrens Hospital. In the current study of non-surgically treated B1 fractures, the follow-up radiographic examination at 1week changed the treatment plan correctly in only 3 cases (<1%). In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA, 2 Chen H, Li Z, Yang D, et al. Lateral Malleolus Fracture: Anatomy, Diagnosis, and Treatment, 6 Natural Ways to Lower Blood Pressure: Lifestyle Changes Can be as Effective as Medication, PCL Injury Recovery: Understanding the Road to Full Recovery, Department of Social and Behavioral Sciences, Department of Global Health and Population, Department of Health Policy and Management, Department of Immunology and Infectious Diseases, The Top Exercises for Managing Diabetes: Taking Control of Your Health, The Impact of Backpacking on Long-Term Physical Health: Exploring the Benefits and Considerations, The Significance of Ultra-Light Gear: Enhancing Outdoor Experiences, Backpacking: The Pathway to Improved Mental Health, How Can Magic the Gathering Help with Depression and Anxiety, Repetitive overload through impact activities such as. Mller ME, Nazarian S, Koch P, Schatzker J. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. Gopinath R, Pigott M, Lindsey B, Finney FT, Holmes JR, Walton DM, Talusan PG. However, a. The fracture also had to be due to low/medium energy and to be a closed injury. abuk H, elebi F, mren Y, Dedeolu SS, Kr M, Uyank AF, Grbz H. J Foot Ankle Surg. A large body of clinical evidence favoring this faction is the demonstrated lack of reliability of reproducible medial tenderness on clinical examination in disclosing the presence or absence of deltoid ligament injury. You can expect to have skin sutures and staples removed typically between 10 to 14 days after surgery. Your surgical team will usually see you to follow-up around 7 to 14 days after surgery. Swedish Fracture Register. The study was approved by the Regional Ethical Review Board, Gothenburg (Reference number: 101115). Cookies policy. In the A2 group, 19% of the fractures were due to high-energy trauma and 8% of the C2 group were open fractures (Table 1). An official website of the United States government. Because there are so many bony parts and ligaments, sometimes only 1 or 2 parts are injured, although many parts can be injured. Lauge-Hansen N. Fractures of the ankle. The fracture is generally below the level of the tibial plafond, with an intact syndesmosis and deltoid ligament. The stability of the joint after an ankle fracture and the necessary treatment hinge on exactly where the break occurs. The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures. It is the most common type of ankle fracture and may happen. Juto H, Moller M, Wennergren D, Edin K, Apelqvist I, Morberg P. Substantial accuracy of fracture classification in the Swedish fracture Register: evaluation of AO/OTA-classification in 152 ankle fractures. Among the surgically treated patients with B1 fractures, 62 (48%) of the patients had medial tenderness and in 44 (34%) patients no comment was made on medial tenderness. 1). BMC Musculoskelet Disord 21, 521 (2020). The fibula runs parallel to the tibia, on the outside of the leg. ESV declares that he has no competing interests. J Bone Joint Surg Am. In addition to the observational data from the SFR, medical records and radiographs were reviewed for all patients registered with an AO/OTA 44 B1 fracture (Fig. 2010;3(4):1. https://doi.org/10.3827/faoj.2010.0304.0001. If the ankle is stable, nonsurgical management produces excellent outcomes. Overview Lateral Malleolus Fracture Lateral malleolus is the name given to the bone on the outside of the ankle joint, called the fibula. Dr Ewout S. Veltman and Dr Rudolf W. Poolman would like to gratefully acknowledge Dr Mohit Bhandari and Dr Brad Petrisor, previous contributors to this topic, as well as Dr Victor A. van de Graaf and Dr Dirk P. ter Meulen for their assistance with the final draft. The results of the study also indicate a lack of consensus on how to classify and treat lateral malleolar fractures at the level of the syndesmosis. Ankle fractures. During this period, Physical Therapy can begin to maintain the mobility of the surrounding tissues, such as the Calf, Peroneal, and Posterior Tibialis muscles. Combined experimental-surgical and experimental-roentgenologic investigations. Part of This could mean a plate and screws, just screws, a nail, or just suture. government site. Aiyer AA, Zachwieja EC, Lawrie CM, Kaplan JRM. Before Bethesda, MD 20894, Web Policies Eur J Orthop Surg Traumatol. The surgical treatment performed for the B1 fracture was open reduction and internal fixation with a fibular plate in 65% and fibular plating combined with the fixation of the syndesmosis in 31%. In most cases, people return to normal daily activities within 3 to 4 months. The most common type of ankle fracture is a lateral malleolus fracture, which can occur when the ankle is twisted or rolled. Next: Symptoms arrow_forward 9. arrow_back Previous: Symptoms. In comparison to earlier studies, it also includes patients that were hospitalized, as well as those treated as out-patients. FOIA Daly PJ, Fitzgerald RH Jr, Melton LJ, Ilstrup DM. volume21, Articlenumber:521 (2020) The ankle joint is made up of several of bones and ligaments. The ankle is made up of three bones: the tibia (large leg bone), the fibula (smaller leg bone), and the talus (first foot bone between the heel and the leg). The patient provided written informed consent for publication of this case report. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Injury. Federal government websites often end in .gov or .mil. The SFR provides a unique opportunity to study the epidemiology of fractures [6]. In addition, a 1-cm 1-cm piece of the articular surface of the posterior malleolus has flipped 90 and logged itself between the posterolateral fracture fragment. To make a diagnosis, an orthopaedic physician will examine your ankle to rule out a more serious, unstable ankle fracture. Lateral Malleolus Fractures are the most common type of ankle fracture, accounting for approximately 55% of all ankle fractures. Medial Ankle Instability: Review of Anatomy, Evaluation, and Treatment. As suggested by Michelson et al. and transmitted securely. 2012;94(22):204752. Wennergren D, Bergdahl C, Ekelund J, Juto H, Sundfeldt M, Moller M. Epidemiology and incidence of tibia fractures in the Swedish fracture Register. reviewed 82 non-surgically treated lateral malleolar fractures, followed by repeated radiographs, and found no secondary displacement at any stage [22]. When this part of the bone fractures, or breaks, it's called a lateral malleolar fracture. May also be called: Lateral Malleolar Fracture. The incidence rate of this injury appears to be similar between genders, but studies have found that it is more prevalent in females as they age. For any urgent enquiries please contact our customer services team who are ready to help with any problems. Ankle fractures are typically very painful and obvious if there is a dislocation (ankle joint out of place) or an open wound. The bone heals gradually over weeks, and a graduated walking and exercise rehabilitation plan is recommended (Figure 2). This is where the ligament is pulled off the bone and in doing so it can pull some flakes or fragments of the bone off with it. Surgical treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study. A lateral malleolus (muh-LEE-uh-lus) fracture is a type of broken ankle that happens when part of the fibula just above the ankle joint fractures. Fractures with more injured parts may be more swollen and may require more incisions. The AO/OTA-classification of ankle fractures, Flow chart of how the study was conducted. Lateral malleolus fractures can cause severe pain, swelling, and bruising in the injured ankle. 2008;90(6):4837. Broken Ankle Broken ankles, or ankle fractures, are one of the most common causes of ankle pain. Stable ankle fracture was defined as an undisplaced isolated lateral malleolar fracture with no medial tenderness or swelling. Examples are shown in Figure 6. 2019;29(6):132530. When a lateral malleolus fracture is accompanied by a sprain of the ligament on the inside of the ankle (the deltoid ligament), your injury may be unstable and may require surgery. A study of 9767 patients with ankle fractures over a period of 9 years found that lateral malleolus fractures are the most common type of ankle fracture, accounting for 55% of all ankle fractures. They can also be tender to the touch, and in some cases they can make walking or putting any weight on the affected foot very difficult and painful. Yde J, Kristensen KD. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. Use of this content is subject to our disclaimer. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The results of the current study can be utilized to improve the treatment for this very common type of ankle fracture and to render the more effective use of healthcare resources. As the bone breaks, the part of the bone that is attached to the tendon or ligament pulls away from the rest of the bone. If the broken bone is not out of place and the ankle is stable, treatment may consist of just wearing a special boot or cast to immobilize the ankle as it heals. Would you like email updates of new search results? Jain N et al. There are several types of Lateral Malleolus Fractures that can occur, ranging from stable to unstable fractures. Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register. Another limitation of the current study is that it only includes patients treated at Sahlgrenska University Hospital. 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