Fractures of the ankle joint: investigation and treatment options

Abstract

Background: Ankle fractures are common, with an incidence of up to 174 cases per 100 000 adults per year. Their correct classification and treatment are of decisive importance for clinical outcome.

Method: Selective review of the literature.

Results: Ankle fractures are initially evaluated by physical examination and then by x-ray. They can be classified according to either the AO Foundation (Association for the Study of Internal Fixation) or the Weber classification. Dislocated fractures need emergency treatment with immediate reduction; this is crucial for the prevention of hypoperfusion and nerve damage. Weber A fractures can usually be treated conservatively, while Weber B and C fractures are usually treated with surgery. An evaluation of the stability of the syndesmosis is important for anatomical reconstruction of the joint. Wound hematoma and wound-edge necrosis are the most common complications, and the postoperative infection rate is 2%. Up to 10% of patients develop ankle arthrosis over the intermediate or long term.

Conclusion: With properly chosen treatment, a good clinical outcome can be achieved. The long-term objective is to prevent post-traumatic ankle arthrosis. The evidence level for optimal treatment strategies is low.

Figures

Figure 1

Algorithm for assessment of anteroposterior and lateral x-rays of the ankle. 1. inspection around the fibula (yellow) 2. inspection around the tibia (pink) 3. inspection around the talus (purple) 4. check tibiotalar distance 5. check fibulotalar distance 6. final check of tibiotalar and fibulotalar joint congruence 7. inspection around the fibula 8. inspection around the tibia 9. inspection around the talus and calcaneus 10. check tibiotalar joint congruence 11. check cyma line (Chopart joint line)

Figure 2

A dislocated ankle fracture (x-rays in two planes)

Figure 3

Ulcerative tissue defects due to pressure from within in longstanding, untreated, non-repositioned ankle fractures