ANKLE FRACTURES
“Shoe, Monte Carlo”, gelatin silver print, Helmut Newton, 1983
A cause may be inconvenient - but it is magnificent. It’s like champagne - or high heels -
one must be prepared to suffer for it!
Arnold Bennett
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Ankle Fractures: Classification, Description, and Complications, Slides of Radiology
An overview of ankle fractures, including their classification using the Danis-Weber system, descriptions of Weber Type A, B, and C fractures, and potential complications. Ankle fractures are common injuries that require urgent attention, especially in severely displaced cases. The document also mentions the importance of neurovascular assessment and history taking, as well as investigations like plain radiography and CT scans.
What you will learn
- What complications can arise from an ankle fracture?
- What is the usual mechanism of injury for a Weber Type A ankle fracture?
- What are the three main types of ankle fractures according to the Danis-Weber classification?
Typology: Slides
2021/2022
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ANKLE FRACTURES
“Shoe, Monte Carlo”, gelatin silver print, Helmut Newton, 1983
A cause may be inconvenient - but it is magnificent. It’s like champagne - or high heels - one must be prepared to suffer for it!
Arnold Bennett
ANKLE FRACTURES
Introduction
Ankle fractures are a common presentation to the Emergency Department.
In severely displaced injuries, urgent reduction is important, even before radiological confirmation of injury.
Classification
There are a number of classification systems that relate to fractures of the ankle.
The Danis-Weber classification is the probably most useful, as it is simple to understand and has relevance to treatment.
The Danis-Weber classification classifies ankle fractures according to the level of the fibula component of an ankle fracture, with respect to the “syndesmosis”.
The syndesmosis refers to the complex of ligaments that bind the lower tibiofibular joint. For practical purposes when reading an x-ray, the syndesmosis is taken as the ankle “joint line”, ie the tibio-talar joint.
There are 3 main types of Weber fracture, Type A, B and C.
Examples are shown in the diagram below and actual radiographs in Appendix 1
C2 Complex diaphyseal fibula fracture.
C3 Proximal fracture of the fibula.
Ligament Disruption:
Significant or total associated ligamentous injury.
Usual Mechanism:
Adduction or abduction with external rotation.
Complications
Most fractured ankles are uncomplicated, and management will be straightforward.
Complications may occur in more severe injuries and may include:
- Compound injuries:
● With subsequent risk of osteomyelitis.
- Vascular compromise with significantly displaced injuries (uncommon).
- Skin compromise with significantly displaced injuries.
● There can be significant skin ischaemia, in this region with severely displaced fractures. Unless there is timely reduction in these circumstances there is a risk of skin necrosis.
- Delayed, mal and non-union, as with any fracture not adequately treated initially.
- Secondary degenerative osteoarthritis
Clinical Assessment
Important points of history
- Mechanism/ circumstances of the injury.
- Last ate (if severe injury that may require ORIF).
- Past history/ co-morbidities/ allergies/ medications.
Important points of examination
- Check neurovascular status.
- Skin compromise (if displaced).
Severe compound fracture-dislocation of the right ankle. Note the pointed tenting of the skin at the apex of the wound. This is from underlying the tibia and puts the overlying skin at risk of ischaemic necrosis, making reduction of the deformity urgent.
- Check if the injury is compound.
- Check ability to bear weight (in more minor injuries).
- Carefully check the exact points of tenderness; a common mistake is to assume a lateral malleolus fracture with lateral ankle/foot pain and not specifically check the base of the fifth metatarsal for tenderness (and the injury is in fact a fractured base of fifth metatarsal).
Investigations
Plain Radiology
Plain radiography will readily diagnose the injury in most cases.
A-P and lateral views are taken.
Specific “foot views” should be requested if there is tenderness over the base of the fifth metatarsal, or if there is any doubt as to the exact location of pain/tenderness.
The “ Ottawa ankle rules” have been established to assist in determining whether or not a plain x-ray is necessary (see separate guidelines for a full description of these).
THE DANIS-WEBER CLASSIFICATION OF ANKLE FRACTURES
Weber Type A Ankle Fracture, (the fracture line lies below the line of the ankle joint).
Weber Type B Ankle Fracture in a 35 yr old male, (the fracture line lies at the level of the ankle joint).
Weber Type C Ankle Fracture, the fracture line lies above the level of the ankle joint.