Ankle Fractures

Ankle fractures are among the most common lower-limb fractures, and the key management question is whether the ankle mortise is stable.

They show a bimodal pattern: young men after high-energy injury and older women after low-energy falls on osteoporotic bone. The spectrum runs from an undisplaced fibular fracture managed without surgery to a trimalleolar fracture-dislocation. Fragility ankle fractures in older adults carry substantial morbidity and are managed within a fragility fracture pathway.

The ankle (talocrural) joint is a mortise formed by the tibial plafond, the 3 malleoli and the talar dome. Stability depends on the bony architecture, the lateral ligaments, the deltoid ligament medially and the distal tibiofibular syndesmosis.

The Danis-Weber classification grades the fibular fracture by its level relative to the syndesmosis:

• •Weber A: below the syndesmosis, usually stable
• •Weber B: at the syndesmosis, stability depends on the medial side and the syndesmosis
• •Weber C: above the syndesmosis, typically unstable with syndesmotic and often deltoid injury

The Lauge-Hansen classification is mechanism-based and used more in research and surgical planning.

A Maisonneuve fracture is a high fibular fracture with a deltoid rupture or medial malleolar fracture and syndesmotic disruption; ankle X-rays miss it.