Ankle fractures can occur after a fall, twist, or direct hit to the bone. Treatment for a broken foot depends on the exact site and severity of the fracture. The deep deltoid ligament is considered the primary stabilizer of the ankle. A stable Lateral Malleolus Fracture is usually managed with 4-6 weeks in a walker boot. For best healing, it is important to follow instructions from your surgeon regarding your post-operative care. Weber B fractures are generally stable fractures that can be managed conservatively with immobilisation and physical therapy. Foot Ankle Int. For unstable fractures, surgery may be required, but with proper rehabilitation, most patients can expect a full recovery. 2023 Jan 29;59(2):262. doi: 10.3390/medicina59020262. When surgeons think about ankle fractures, we think in terms of these bony parts and ligaments. When this part of the bone fractures, or breaks, it's called a lateral malleolar fracture. The current study also makes a deeper analysis of the way lateral malleolar fractures, AO/OTA 44B1, were examined, classified and treated over the same time period at one of Swedens largest orthopedic centers. Foot Ankle Spec. Medial Ankle Instability: Review of Anatomy, Evaluation, and Treatment. MECHANISM OF LATERAL MALLEOLUS FRACTURE. This is usually followed by imaging to rule out other conditions and to confirm the diagnosis. Due to its position and role in weight-bearing, it is more commonly injured than the medial malleolus. Isolated lateral malleolus fractures are the most common fracture involving the ankle. Would you like email updates of new search results? 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. Springer Nature. PubMedGoogle Scholar. Symptoms Symptoms of a medial malleolus fracture can include: immediate severe pain swelling around the ankle bruising tenderness to pressure inability to put weight on the injured side. Accessibility These types include: lateral malleolus . 2009;91(5):10429. Fibula fractures occur around the ankle, knee, and middle of the leg. 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. Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register. Open access funding provided by University of Gothenburg. 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. Medial Malleolus Fractures. 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. Note: All information is for educational purposes only. Arbeitsgemeinschaft fr Osteosynthesefragen. Ankle fractures are easily diagnosed with plain radiography. Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Google Scholar. 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). The bone heals gradually over weeks, and a graduated walking and exercise rehabilitation plan is recommended (Figure 2). Flow chart of how the AO/OTA 44B1 fractures that were initially assigned to non-surgical treatment were followed up and eventually treated. You may require several months of physical therapy to be able to return to your prior activities. Broken Ankle Broken ankles, or ankle fractures, are one of the most common causes of ankle pain. 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. As this distinguishes if the fracture is stable or not it affects the choice of subsequent treatment. Both a lateral malleolar fracture without an impaired deltoid ligament (SER-II or B1) and the combination of a lateral malleolar fracture with a deltoid ligament rupture (SER-IV or B2) appear as unimalleolar on plain radiographs (Fig. 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. Among the patients with C3 fractures, the mean age was 47years and 76% of the patients were men (Table 1). 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. While radiography is still the most common diagnostic adjunct used for diagnosing an ankle fracture, point of care ultrasonography is very popular in the ED. A Danis-Weber Type B is a fracture at the level of the syndesmosis and has variable stability. 1). MB and BP declare that they have no competing interests. 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 focused physical examination showed tenderness and edema near over the posterior edge of left lateral malleolus. The patient provided written informed consent for publication of this case report. 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. 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. Epub 2018 Apr 19. If the ankle is dislocated, you may need a reduction, which means the doctor will manipulate the foot and ankle back in to position with his or her hands, and then apply a splint or boot. In the current study, 79% of the surgically treated B1 patients and 50% of the non-surgically treated patients had some kind of weight-bearing restriction in addition to immobilization. Acta Orthop. In SFR ankle fractures are classified according to the Arbeitsgemeinschaft fr Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification [15, 16] (Fig. The posteromedial fragment extends into the posterior colliculus of the medial malleolus and has a subchondral impaction fracture. implemented guidelines aiming to diagnose stable ankle fractures reliably and manage them with no follow-up radiographs [20]. Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture. 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]. A trimalleolar fracture can have long-term impact on your quality of life. For the remaining 73 patients initial treatment or follow up was conducted at another hospital or medical records was not found or could not be accessed therefore they were not included in the study (Fig. The Miller School of Medicine, University of Miami, Miami, Florida, USA, 3 EMR conducted the study and the statistical calculations, created the figures and tables, analysed data and wrote the final draft of the manuscript. Of all ankle fractures, 93% were due to low-energy trauma and 98% were closed fractures. It would also minimize the number of radiographs per patient, reducing both costs and unnecessary risks. Sanders DW, Tieszer C, Corbett B, Canadian Orthopedic Trauma S. Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. 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. She denied any smoking, recreational drug or alcohol use. arrow_back Previous: Symptoms. and transmitted securely. and the current study further support the hypothesis that, with the right guidelines strictly to distinguish stable from unstable ankle fractures, the stable fractures can be successfully treated non-surgically, with full weight-bearing allowed and with no need for follow-up radiographs. Google Scholar. The SFR provides a unique opportunity to study the epidemiology of fractures [6]. Like the original injury, surgery produces swelling and swelling can put tension on your wounds. For all authors, none was declared. 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. 2023 Johns Hopkins All Childrens Hospital. The picture in Figure 4 shows a patient with a fractured ankle that is dislocated and pushing against (tenting) the skin. We found that ankle fractures are common in all age groups and both sexes. Since the two fracture types might appear similar on plain radiographs, the physical examination of the patient is a crucial part in the decision-making regarding treatment method. The bony parts are connected to one another by ligaments. In addition, 2 of the non-surgically treated patients were treated surgically at a later stage due to non-union. A lateral malleolus fracture is a type of ankle fracture that occurs when the fibula fractures just above the ankle joint. 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. 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Each of these bones has critical parts that work to hold the ankle together while still allowing motion. Call our Ankle Fracture Line at 833.294.9759 Anatomy of the ankle joint 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. National Library of Medicine The stirrup portion of the splint prevents inversion and eversion while the posterior ankle portion prevents plantarflexion and dorsiflexion. Arch Surg (Chicago, Ill : 1920). Appointments 216.444.2606 The Comprehensive Classification of Fractures of Long Bones: Springer Verlag; 1990. https://link.springer.com/book/10.1007%2F978-3-642-61261-9. government site. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. It can take weeks or months for you to recover from an ankle fracture. 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. 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%. Jain N, Symes T, Doorgakant A, Dawson M. Clinical audit of the management of stable ankle fractures. Northwestern Medicine is a trademark of Northwestern Memorial HealthCare, used by Northwestern University. In younger patients, your doctor may recommend removal of the hardware, fusion, or other surgery. Lauge-Hansen N. Fractures of the ankle. In their study, 75% of the isolated lateral malleolar fractures (Weber type A or B) were treated non-surgically. Among the 439 patients registered with B1 fractures, 309 patients (70%) were treated non-surgically and 130 (30%) surgically. Edited by the OTA Patient Education Committee The medial malleolus may be fractured or deltoid ligament may be torn. In comparison to earlier studies, it also includes patients that were hospitalized, as well as those treated as out-patients. Upon removal of the boot, rehabilitation can last for 4-6 weeks. 1950;60(5):95785. Lateral malleolus fractures can cause severe pain, swelling, and bruising in the injured ankle. The .gov means its official. Reddyreddy S, Stead T, Mangal R, Lopez-Ortiz C, Wilson J, Ganti L. Orthop Rev (Pavia). Most ankle fractures can be visualized on X-rays. 1 A considerable number of these patients with medial tenderness, especially the ones where the responsible physician decided to treat surgically, can be suspected of having had a medial ligament injury and were not classified correctly. Request an Appointment. HCA Centralized Algorithms for Research Rules on IRB Exemptions (CARRIE)/IRB manager issued study exemption 2022-559. The three procedures are: For the lateral malleolus fracture . After reduction and splint application, your healthcare provider will explain if he or she thinks surgery is needed, and will most likely refer you to an orthopaedic surgeon for evaluation and further treatment. Wykes PR, Eccles K, Thennavan B, Barrie JL. BMC Musculoskelet Disord 21, 521 (2020). As trimalleolar fractures are often unstable, a doctor will usually recommend surgery as treatment. These fractures are stable and typically do not require surgery. Patients with a lateral malleolus fracture may also experience swelling, bruising and pain on firmly touching the affected region of bone. Appointments & Locations. 31 It is unclear as to what degree of deltoid injury in the face of the fibular fracture will allow for clinical instability. Review the latest information on visitor policies, safety procedures, vaccines, and more in the COVID-19 Resource Center. 9. Thur CK, Edgren G, Jansson KA, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. The main bones are the tibia, fibula, calcaneus and cuboid. The patient was fitted with crutches and instructed on proper crutch use and ways to care for the injury. Broken Ankle? Pakarinen HJ, Flinkkil TE, Ohtonen PP, Ristiniemi JY. At our department all non-surgically treated B1 fractures are followed up at 1week with a radiographic examination. 2023 BioMed Central Ltd unless otherwise stated. Before In some cases, though, surgery has to be performed to align the bone and hold it together with metal plates, rods, or screws. An evaluation of the Weber classification of ankle fractures. Your privacy choices/Manage cookies we use in the preference centre. and transmitted securely. BMC Musculoskeletal Disorders Article Note: All information is for educational purposes only. Federal government websites often end in .gov or .mil. 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]. To make a diagnosis, an orthopaedic physician will examine your ankle to rule out a more serious, unstable ankle fracture. Get quick access to an HSS orthopedic surgeon. Jain N et al. Stability criteria for nonoperative ankle fracture management. Management of a rare giant cell tumor of the distal fibula: A case report. 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. This results in a small, often unstable fragment. The most common type of ankle fracture is a lateral malleolus fracture, which can occur when the ankle is twisted or rolled. Surgical incisions around the ankle are at higher risk for wound complications than skin in other areas. Emilia Mller Rydberg. 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]. Please note the date of last review or update on all articles. 3). Ankle fractures. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Stretching and strengthening exercises supervised by a doctor or physical therapist can help improve ankle function and mobility during the healing process. Her vital signs were: temperature 36.40C, blood pressure 129/81 mmHg, respiratory rate of 19 breaths per minute, heart rate of 97 beats per minute, oxygen saturation of 100% on room air. From the medical records information regarding signs of medial ligament injuries found at the initial physical examination was obtained as well as instructions regarding weight bearing restrictions and immobilization period. Miller AG, Margules A, Raikin SM. 2016;47(11):257983. This probably reflects a lack of understanding of the classification of ankle fractures. PMC She was discharged from the ED with orthopedics follow up within 48 hours. Gopinath R, Pigott M, Lindsey B, Finney FT, Holmes JR, Walton DM, Talusan PG. Displaced fractures are commonly treated with an open . Complication rates following open reduction and internal fixation of ankle fractures. Ankle fractures are typically very painful and obvious if there is a dislocation (ankle joint out of place) or an open wound. In some cases, though, surgery has to be performed to align the bone and hold it together with metal plates, rods, or screws. Lateral Malleolus Fracture Symptoms. Wennergren D, Ekholm C, Sandelin A, Moller M. The Swedish fracture register: 103,000 fractures registered. statement and A clinical interview of your symptoms alongside a clinical examination can often be sufficient to achieve a diagnosis for your therapist. Primary and late results of operative and non-operative treatment. There is evidence supporting the benign course of B1 fractures. Lateral malleolus . Management of Isolated Lateral Malleolus Fractures. 2015;16:338. You can have pain and swelling on the inner side of the ankle in addition to the lateral malleolus fracture. PHC declares that he has no competing interests. Injury. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. This indicates that there is no need to check these fractures with radiographs at 1week as a matter of routine, saving money, time and radiation. FOIA 439 of the patients with B1 fractures were included in the detailed study and of these 309 (70%) were treated non-surgically and 130 patients (30%) surgically. MS planned and conducted the study and revised the manuscript. 8600 Rockville Pike The non-surgically treated patients had an average of 3.3 outpatient visits, including the initial visit to the A&E, and this group had an average of 0.2days of inpatient care. The most common malleolus fracture happens at the fibula. Fractures with more injured parts may be more swollen and may require more incisions. The .gov means its official. 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. Before 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. This could be interpreted as either indicating that the finding of medial tenderness was not equal to a significant structural medial ligament injury or that some B2 fractures can be treated non-surgically. In 2 of these patients, a slight lateralization of the talus at the 1-week follow-up was found and stability tests in the operating theatre confirmed what were regarded as unstable fractures. May be associated with a dislocation of the ankle joint. Knutsson SB, Wennergren D, Bojan A, Ekelund J, Moller M. Femoral fracture classification in the Swedish fracture Register - a validity study. Inclusion in an NLM database does not imply endorsement of, or agreement with, Reduction is usually done after pain medications have been given, and these can include oral, intravenous, or local pain medications. In general, it takes at least 6 weeks for the broken malleolus to heal. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The classification of malleolar fractures, as well as treatment of them, is a matter of debate. 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). lateral malleolus, lateral malleolar fracture, ankle fracture, Danis-Weber classification, 1. eCollection 2022 Oct. Frederiksen JO, Malmberg C, Karimi D, Tengberg PT, Troelsen A, Terndrup M. J Orthop Surg Res. Lateral malleolus fractures are often stable and can be treated without surgery. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. The authors present the case of a young woman who sustained a lateral malleolar fracture. The superficial components of the deltoid ligament include the tibiocalcaneal and tibionavicular ligaments. medial and/or lateral malleolus swollen and tender to palpation, tenting of the skin over the medial malleolus, plain x-ray 'stress view' or a standing anteroposterior x-ray. The syndesmosis joint provides stability. Rosemont, IL 60018-4975, Phone: (847) 698-1631 The talus is a small bone that sits on top of the heel bone, and it forms the lower part of the ankle joint. Aiyer AA, Zachwieja EC, Lawrie CM, Kaplan JRM. Federal government websites often end in .gov or .mil. You may require the use of a walker boot after surgery, and rehabilitation with a Physical Therapist can last for 6-12 weeks. CAS Smoking has been shown to slow healing after ankle fracture surgery, so if you smoke, you should not do so at this time. Fracture and dislocation classification compendium - 2007: Orthopaedic trauma association classification, database and outcomes committee. The seriousness of a broken foot varies. For all of the non-surgically treated patients, the treatment was converted to surgical treatment at an early stage in 5 patients (1%). 3). 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. Stress fractures often don't show up on X-rays until the break actually starts healing. These fractures are often caused by traumatic events such as falls or trips, but can also result from overuse injuries or poor biomechanics. 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. 50 It is unclear as to what degree of deltoid injury in the face of the fibular fracture will allow for clinical instability. Among the surgically treated patients 18% (n=24) were found to have no medial tenderness. Wennergren D, Ekholm C, Sundfeldt M, Karlsson J, Bhandari M, Moller M. High reliability in classification of tibia fractures in the Swedish fracture Register. There is usually widening of the distal tibiofibular articulation and medial malleolus fracture or deltoid ligament injury may be present. Bone scan. The fibula is the smaller of two bones of the lower leg, situated between the knee and ankle, that helps keep the ankle joint stable. It is called a lateral (outside of the ankle) malleolus fracture and is depicted in Figure 5. 2). X-rays of the patients left ankle revealed a transverse fracture of the lateral malleolus (Figure 1). Taping and/or an ankle brace may be used when returning to activities that require a change of support, especially for those with unstable ankles. 2012;83(3):27681. 2018;49(11):206874. Arch Orthop Trauma Surg. 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. The tibiofibular syndesmosis is usually intact or only partially torn, but there is no widening of the distal tibiofibular articulation. All content 2022 Orthopaedic Trauma Association unless otherwise noted. ??accessibility.screen-reader.external-link_en_US?? The dorsalis pedis pulse was intact, and there were no open wounds. 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. If a lateral malleolar fracture is classified as B1, despite having an injury to the medial structures, and undergoes surgical treatment, there is clearly a lack of understanding of the AO/OTA-fracture classification but a possible correct treatment. 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. 1). Negative prognostic factors in surgical treatment for trimalleolar fractures. Daly PJ, Fitzgerald RH Jr, Melton LJ, Ilstrup DM. The fracture had to be at or below the inferior tibiofibular joint and there should be no medial/posterior malleolar fracture. 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. There was no tenderness to the base of the 5th metatarsal, or over the fibular head. 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. For unstable Lateral Malleolus Fractures or a malunion, surgery may be required. The knob on the outside of the ankle, the lateral malleolus, is the end of the fibula, the smaller bone in the lower leg. Ankle fractures are commonly a low-energy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus. It is called a lateral (outside of the ankle) malleolus fracture and is depicted in Figure 5. Advanced imaging may not be accurate for guiding management. This involves strengthening and mobility exercises of the foot and ankle. The site is secure. A stress x-ray is depicted in Figure 3B, and shows instability when compared to the image in Figure 3A. According to Swedish legislation, National Quality Registers do not require signed consent from the individual registered patient. 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. 2023 by Northwestern Medicine and Northwestern Memorial HealthCare. FOIA In most cases, people return to normal daily activities within 3 to 4 months. Cite this article. 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. 1 The ends of these bones, with the bony bumps you see on the inner and outer side of the ankle, are called the medial malleolus (tibia) and lateral malleolus (fibula). Radiographs were reviewed in cases were treatment deviated from standard care to make sure the fracture classification was correct. 2. The worse the injury, the more likely it will be unstable. Accessibility You may be sent home with crutches or some other form of assistive device to help keep weight off your ankle. The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA, 2 BMC Musculoskelet Disord. Your surgical team will usually see you to follow-up around 7 to 14 days after surgery. 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. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. Symptoms Diagnosis A fibula fracture occurs when there is a partial or complete break of the fibula bone. The bony parts of the fibula and tibia are called malleoli (singular = malleolus). A Danis-Weber Type C fracture is always unstable and occurs proximal to the level of the syndesmosis. Your talus is the main connection between your foot and your leg. The https:// ensures that you are connecting to the Risk factors for wound complications after ankle fracture surgery. 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. reviewed 82 non-surgically treated lateral malleolar fractures, followed by repeated radiographs, and found no secondary displacement at any stage [22]. Here are some of the most common types of Lateral Malleolus Fractures: This type of fracture occurs at the ankle level of the lateral malleolus and may extend up the fibula. found that non-surgically treated patients had less pain and a better functional score compared with surgically treated patients [19]. This site needs JavaScript to work properly. Lateral malleolus is the name given to the bone on the outside of the ankle joint, called the fibula. Careers, Unable to load your collection due to an error. 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. Please enable it to take advantage of the complete set of features! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). An official website of the United States government. All authors have given final approval of the version to be published. An official website of the United States government. The study was approved by the Regional Ethical Review Board, Gothenburg (Reference number: 101115). 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. Ankle fractures: supination-eversion fractures of stage IV. Unauthorized use of these marks is strictly prohibited. 27% of the surgically treated patients had outpatient surgery with discharge the same day. 4). This is to protect your skin and surgical incisions while supporting your ankle in a neutral position to prevent stiffness in your calf. The results of Michelson et al., Jain et al., Wykes et al. Epub 2022 Oct 10. 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. Of these, 512 were classified as B1 fractures, of which 439 were both initially treated and followed up at SU and were included in the detailed study. Terms and Conditions, This complication can occur with or without surgery, and you should discuss this with your surgeon to determine your treatment options. 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 . 8. 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. Rydberg, E.M., Zorko, T., Sundfeldt, M. et al. The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1week. Yde J, Kristensen KD. official website and that any information you provide is encrypted The most common malleolus fracture happens at the fibula. . ESV declares that he has no competing interests. 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. As a library, NLM provides access to scientific literature. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone. This is often an ORIF involving metalwork such as a plate stabilising the broken bone. the contents by NLM or the National Institutes of Health. 2007;21(10 Suppl):S1S133. Treatment for broken ankles depends on the fracture. Pain may also increase during certain movements of the foot or ankle or when standing or walking (particularly up hills or on uneven surfaces) or when attempting to stand or walk. The isolated lateral fracture (B1/SER-II) is by nature stable, suitable for non-surgical treatment and should not be exposed to the risk of complications due to surgery [10,11,12]. Historically a cast was used, but the walker boot allows for greater function and equivalent healing response. For specific medical advice, diagnoses, and treatment, consult your doctor. Isolated malleolar fractures make up 70% of all ankle fractures, followed by bimalleolar and trimalleolar fractures.8 In isolated malleolar fractures, the key is to determine the stability of the deep deltoid ligament.9 A stable ankle joint is treated initially with splinting, followed by casting and/or walking boot. Fractures of the medial malleolus are relatively uncommon. In conclusion, Lateral Malleolus Fractures are a common type of ankle fracture that can be caused by a variety of factors. This occurs as tendons can bear more load than the bone. Copyright 2023 Center for Health and the Global Environment. 2017;18(1):251. 7. Because medial malleolus fractures tend to occur in younger patients, problems arising from a growth disturbance can be more severe. Talus fractures usually occur due to high-impact injuries such as car accidents. 2018 Jul-Aug;57(4):712-715. doi: 10.1053/j.jfas.2017.12.009. Minimizing that tension can help reduce the risk of infection and also helps with pain. Lee TH, Jang KS, Choi GW, Jeong CD, Hong SJ, Yoon MA, Kim HJ. After surgery, you will most likely be in a plaster splint or fracture boot. The best way to determine whether or not a lateral malleolar fracture at the level of the syndesmosis has an associated deltoid ligament injury has not been fully elucidated. Nevertheless, some authors recommend conservative treatment for certain type of Maisonneuve fractures in case of partial disruption of the syndesmosis, in the absence of diastasis, or in the absence of ligament or bone lesion of the medial malleolus (8,17). Fractures can range from tiny cracks in your bones to breaks that pierce your skin. The patient claimed that the pain and swelling began immediately afterwards but that she did not experience numbness, tingling, or weakness. An analysis of data from the SFR relating to fracture classification, age, sex, cause of injury, frequency of high/low-energy trauma and frequency of closed/open fracture was conducted. The stability of the joint after an ankle fracture and the necessary treatment hinge on exactly where the break occurs. There is an apparent difficulty in clinically determining whether or not a lateral malleolar fracture has an associated injury to the medial ligament. It acts as a weight-bearing structure, absorbing approximately 10% of the weight in standing. The ankle joint is made up of several of bones and ligaments. National Library of Medicine The bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural form of malleolus. 2016;47(2):47882. Pakarinen HJ et al. The main ligament is the deltoid ligament. Examples of non-operatively and operatively treated fractures are seen in Figure 7. In contrast to this, in the current study, 130 patients (30%) classified as having sustained a B1 fracture were treated surgically. Privacy 47% of the fractures were caused by a fall on the same level due to slipping, tripping or stumbling. When a child twists their ankle, the medial malleolus can fracture. If the ankle is not dislocated and it is not obvious if the fracture is stable or not, a stress x-ray may be needed. Another limitation of the current study is that it only includes patients treated at Sahlgrenska University Hospital. Treatment usually requires surgery, and the recovery process can take months. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment. A bone scan can help your doctor diagnose fractures that don't show up on X-rays. Depending on your needs, your surgical team may choose to initiate formal physical therapy at this time or delay physical therapy until a later date. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. May also be called: Lateral Malleolar Fracture. Lateral malleolus fractures cause pain, swelling, and bruising around the ankle. For some older people, ankle replacement may be an option if symptoms get too severe. Signs and Symptoms. On the other hand, of all the B1 fractures treated non-surgically, despite having medial tenderness, in only 1 case the treatment was changed to surgical at an early stage. 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. On the other hand, the B2 or SER-IV fracture with a fracture pattern that proceeds to the medial side is possibly unstable and better suited to surgical treatment [13, 14]. Displaced fractures are commonly treated with an open reduction and internal fixation. Thur et al. The most commonly affected age group was 5665years. The deep components of the deltoid ligament consist of the anterior and posterior tibiotalar ligaments. Summary. The patient stated that she was walking out of her home with two steps when she tripped and fell, causing an inversion injury to her left foot. Injury. Among the patients registered in the SFR as having sustained a B1 fracture, the sex distribution was 47% men and 53% women. 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. 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. From medical records it was noted if stability tests had been performed and if there were any significant concomitant injuries. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Use of this content is subject to our disclaimer. DW planned and conducted the study, analysed data and revised the manuscript. Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures. Observational data regarding all ankle fractures treated at SU between 1 April 2012 and 31 March 2014 was collected from the Swedish Fracture Register. During the 2 consecutive years from 1 April 2012 and 31 March 2014, 1328 patients with ankle fractures were treated at SU. In the vast majority of cases (97%), plain radiographs were the only radiographic imaging modality used. Ankle fractures occur in people of all ages and are among the most common injuries treated by an orthopaedic surgeon. 7. There are several types of Lateral Malleolus Fractures that can occur, ranging from stable to unstable fractures. The main bones are the tibia, fibula, calcaneus and cuboid. Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature. For the 73 (24%) non-surgically treated patients with medial tenderness, the treatment plan was changed to surgical treatment after the 1-week follow-up in 1 patient and 1 patient was treated surgically after 3months due to non-union (Fig. A lateral malleolus fracture can be treated with self-care through rest, elevation, ice application and anti-inflammatory medications. Consequently, by definition, a 44B1 fracture has no significant rupture of the medial ligaments. Stable ankle fracture was defined as an undisplaced isolated lateral malleolar fracture with no medial tenderness or swelling. BMC Musculoskelet Disord. There are different types of fractures, which can also affect treatment and recovery. World J Clin Cases. The results of the study reveal the application of the AO/OTA classification and real-life treatment algorithms. After this initial exam, x-rays are usually performed to help define the bony injury and some form of splint may be applied. Despite this, we think this is an important finding, since the data in the current study were extracted from a national quality register used by clinicians and thereby represent real life. Early diagnosis and treatment can lead to a successful outcome, and conservative treatment is often sufficient for stable fractures. On the Danis-Weber scale, this fracture would be classified as Type A, as it is inferior to the syndesmosis. Stead TS, Pomerantz LH, Ganti L, Leon L, Elbadri S. Acute Management of Trimalleolar Fracture. A lateral malleolus fracture can be treated with self-care through rest, elevation, ice application and anti-inflammatory medications. Rehabilitation exercises are similar to that of a sprained ankle. J Orthop Trauma. 2017 Mar;22(1):35-63. doi: 10.1016/j.fcl.2016.09.004. Review of systems was otherwise negative. She was unable to bear weight initially. 2023 Johns Hopkins All Childrens Hospital. 91 Topic Podcast Images Summary Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. The medial malleolus is the boney bump on the inside of the ankle. No other injuries were sustained. 2012;94(22):204752. When a lateral malleolus fracture is accompanied by a sprain of the ligament on the inside of the ankle (the . The difference in immobilization time corresponds well to the average 4.6days that the surgically treated patients had to wait for their surgery. 2019;29(6):132530. MeSH 1. Bethesda, MD 20894, Web Policies 8600 Rockville Pike The lateral malleolus can fracture at a number of different levels, and treatment often depends on where the fracture is located. Injury. This consists of either interlocking intramedullary nails or an anatomical locking plate.4 For example, in Weber-B patients, intramedullary nails are preferred over locking plates for their consistently superior results.5 The fracture will take anywhere between 2-12 weeks to heal, so continual inspection is advised. 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. The Emergency Departement presentation, diagnosis and initial acute treatment is discussed. Epub 2020 Apr 5. J Trauma. The ankle joint is made up of several of bones and ligaments. Hong P, Ding Y, Xu R, Rai S, Liu R, Li J. Medicina (Kaunas). 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. Unstable injuries benefit from surgery to provide stability to the ankle joint as a whole and to the individual fractured parts. 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 fracture also had to be due to low/medium energy and to be a closed injury. Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register, https://doi.org/10.1186/s12891-020-03542-5, https://link.springer.com/book/10.1007%2F978-3-642-61261-9, https://doi.org/10.3827/faoj.2010.0304.0001, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmcmusculoskeletaldisorders@biomedcentral.com. The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures. The AO/OTA-classification of ankle fractures compared with the Lauge-Hansen classification of SER-injuries (supination-external rotation). CCB is an author of several references cited in this topic. For 3 of the patients, however, the medical charts and radiographs did not reveal any clear indication for converting to surgical treatment. 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. 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). Review the latest information on visitor policies, safety procedures, vaccines, and more in the COVID-19 Resource Center. Treatment includes surgery and extensive physical therapy. Post-operative complications include nerve damage if a nerve is cut during the procedure, but these surgeries are generally very successful overall. All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts. By using this website, you agree to our 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. Mller ME, Nazarian S, Koch P, Schatzker J. Stenquist DS, Miller C, Velasco B, Cronin P, Kwon JY. A talus fracture is a broken bone in your ankle. 1 ). If the ankle is stable, nonsurgical management produces excellent outcomes. Lateral Malleolus Fractures can be caused by a variety of factors, including: A consultation with a Physical Therapist, Podiatrist, or Sports Medicine Doctor is recommended if you have any of the symptoms of a Lateral Malleolus Fracture. Other bones around the ankle joint can be injured as well, but an ankle fracture usually involves the bones of the tibia and fibula. Wennergren D, Bergdahl C, Ekelund J, Juto H, Sundfeldt M, Moller M. Epidemiology and incidence of tibia fractures in the Swedish fracture Register. Ann R Coll Surg Engl. TZ planned and conducted the study, analysed data and revised the manuscript. 2008;90(6):4837. When they do occur, they are usually part of a more complex pattern of ankle fractures. Stretching and strengthening exercises supervised by a doctor or physical therapist can help improve ankle function and mobility during the healing process. Most inversion injuries result in an isolated sprain of the anterior talofibular ligament. 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. Eur J Orthop Surg Traumatol. 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. However, posterior syndesmotic injury in the form of tibial avulsion fracture of the . Injury. Graded exposure to impact activities and return to play protocols if you wish to return to sport. Surgery is not usually required for a stable fracture. In the case that clinical/radiographic findings are indicative of ankle instability, surgical fixation options include lateral or posterolateral plating or intramedullary fixation. 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 Symptoms Treatment Recovery A medial malleolus fracture can happen during activity when your foot collapses inward or rotates too far outward. 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). It is the most common type of ankle fracture and may happen. Diagnosis is made with plain radiographs of the ankle. 27% of all B1 fractures (73% of the surgically treated and 8% of the non-surgically treated) were admitted to hospital. Examples include isolated lateral malleolar fractures without deltoid sprain and some nondisplaced medial malleolar fractures. 96% of the fractures were due to low-energy trauma and 99% were closed injuries. Improvement in the treatment of stable ankle fractures: an audit based approach. The site is secure. 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. The treatment plan was based on common knowledge in the field and the decision to treat surgically or not was made by the attending surgeon. sharing sensitive information, make sure youre on a federal University of Medicine and Dentistry of New Jersey. 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