Pain in other locations of the foot and ankle need to be need to suspect a more severe ankle injury than an isolated lateral malleolus fracture. Lateral malleolus fractures trigger pain, swelling, and bruising around the ankle. The bright side is that the majority of lateral malleolus fractures are considered steady ankle fractures and can be treated without surgery. These injuries generally occur when the ankle is either twisted or rolled, frequently with an awkward or unequal action. The tibia brings the main amount of the weight of the body (about 90 percent), with the fibula holding only about 10 percent of body weight.įractures of the lateral malleolus are the most common type of ankle fracture. This bone is part of the fibula, one of two bones of the leg the other leg bone is called the tibia (shin bone). To do this, emergency physicians need to employ stress radiographs to assess the stability of the ankle joint.This trauma know as injury to the distal fibula of the ankle as well. The lateral malleolus is the name provided to the bone on the outside of the ankle joint. 3 For this reason, assessing deltoid ligament integrity is of critical importance in determining the stability of an ankle fracture. 5Ĭlinical signs such as medial ankle pain, swelling, and ecchymosis are not reliable in identifying a deltoid ligament injury. 4 In what appears as an otherwise isolated Weber B fibular injury, a tear of the deltoid ligament can be considered “equivalent to a medial malleolar fracture,” qualifying the fracture mechanically as unstable, thus requiring operative management. A talar shift of 1 mm results in a 42 percent decrease in tibiotalar contact area, which can lead to significant increases in contact stress. The deltoid ligament, which runs from the medial malleolus to the calcaneus, talus, and navicular bones, plays a vital role in maintaining correct talus positioning. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular ligaments and the deltoid ligament. Any bi- or trimalleolar fracture should be considered unstable because of the disruption of the bony architecture on both the medial and lateral side of the joint. Unstable ankle fractures are one of the primary indications for orthopedic referral. In general, most stable ankle fractures can undergo nonoperative management by a primary care physician. The primary consideration regarding need for operative management of a closed ankle fracture is stability. The focus of this article is to help emergency physicians choose the proper method for determining that stability. 3 These type B fractures are sometimes stable, and patients can ambulate on them as tolerated in other cases, they are unstable and require open reduction and internal fixation (ORIF). Weber B fractures occur at the level of the tibiofibular ligaments, just above the talar dome, and happen primarily through a mechanism of ankle supination and external rotation (SER). Weber C fractures are almost always unstable and require surgical intervention. Weber C fractures are above the ankle joint and are associated with a syndesmotic injury. Injuries to the distal fibula, below the talar dome, are classified as type A and are stable fractures. Tips for Diagnosing Occult Fractures in the Emergency DepartmentĮxplore This Issue ACEP Now: Vol 39 – No 04 – April 2020.Tips for Catching Commonly Missed Ankle Injuries.Tips for Managing Suspected Occult Fractures.
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