Overview

• Eversion or inversion injury

• Direct trauma

  • Crush injury

  • Axial loading (e.g., fall from a height, motor vehicle collision)

• Lateral malleolar fracture

• Medial malleolar fracture

• Posterior malleolar fracture

• Bimalleolar fracture: fractures of the lateral and medial malleoli

• Trimalleolar fracture: fractures of the lateral, medial, and posterior malleoli

• Pilon fracture: fracture of the distal tibia involving the articular surface of the talocrural joint

• Maisonneuve fracture: fracture of the proximal fibula associated with disruption of the distal tibiofibular syndesmosis and medial malleolar injury (i.e., medial malleolar fracture, deltoid ligament rupture) [2]

• Other: Volkmann triangle refers to an avulsion fracture of the posterolateral tibial lip

The ankle becomes increasingly unstable with worsening severity of injury. Generally, fractures at two or more sites are unstable.

• Usually stable: isolated lateral malleolar fracture or isolated medial malleolar fracture

• Usually unstable: posterior malleolar fracture, bimalleolar fracture, Maisonneuve fracture

• Always unstable: trimalleolar fracture, pilon fracture

• Local pain, swelling and hematoma

• Tenderness, especially in the area of the malleoli, the syndesmosis, and the posterior aspect of the ankle joint

• Restricted range of movement

• Skin abnormalities (lacerations, discolorations, tenting, or blistering)

• If separation of the ankle mortise elements occurs: lateral displacement of the foot

• In some cases, accompanying injury (e.g., fracture of the proximal fibula, knee, or foot)

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