Patients › Ankle

Ankle fracture fixation

Updated Sep 2026

Why this operation has been suggested¶

Ankle fracture fixation is an operation that holds the broken bones of your ankle in place while they heal. It is typically offered when the fracture is unstable, meaning the broken pieces have moved apart or are likely to. Some fractures that are not displaced, or can be nudged back into place and stay put, can be managed without surgery in a plaster, with close monitoring. For acute injuries like a broken ankle, we may recommend surgery straight away rather than trying non-operative care first. The goals of treatment are a healed fracture and an ankle that moves and functions normally without pain.

Before the operation¶

Once surgery is planned, a few simple preparations help the day go smoothly. You will be given clear instructions about fasting: nothing to eat or drink for seven hours beforehand. We ask for seven hours rather than six so you can be brought forward if the theatre list runs early. Some medications may need to be paused, so bring a written list of everything you take and your surgeon will advise which ones to stop. Arrange for someone to drive you home afterwards, as you will not be in a fit state to drive. Wear loose, comfortable clothing. X-rays are usually all that is needed to plan the operation, though an MRI (a scan that shows soft tissues such as ligaments) or an ultrasound may occasionally be arranged. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the specialist who looks after you during the operation).

On the day¶

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist, the specialist who looks after you during the operation. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.

You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery. If you go home the same day, you will need someone to drive you, as arranged beforehand.

What the operation involves¶

The aim of the operation is to put the broken pieces of bone back into their normal position and hold them there while they heal. Getting the bones back to their normal length and alignment matters, because this is what restores the way your ankle works.

Your surgeon makes a cut (or cuts) over the broken part of your ankle to reach the bone. The broken pieces are moved back into place, then held with metal plates, screws or a rod inside the bone. Which method is used depends on which bone is broken and how the pieces have moved. If a smaller fragment at the back of the ankle is involved, it can be reached through a cut on the outer side of the ankle and fixed in place. If the joint between the two shin bones has been torn apart, it may be held together with screws or a flexible band while the ligaments heal.

The wound is closed with stitches and covered with a dressing. The dressing stays on for about 10 days; the 'After the operation' section explains what happens then.

After the operation¶

For the first day or two, your main job is rest. You wake up in the recovery area, then move to the ward when you are ready. Your foot will be in a dressing, and your ankle may be supported in a plaster or a removable boot to protect it while it settles. Pain relief is planned for you before the numbness wears off, so tell the nurses how you are feeling and they can adjust it. You will be shown how to move around without putting weight on the sore foot, using crutches or a frame. Someone should stay with you for the first 24 hours after you get home. Your team will tell you whether you go home the same day or stay one night in hospital. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.

Recovery¶

Expect soreness and swelling in the first days and weeks. This is a normal part of healing. Rest, keeping the foot raised, and the pain relief plan made for you in hospital all help ease it. The swelling usually settles gradually as the ankle heals.

In the early days your job is simple: rest, keep the foot up, and move around safely without putting weight on the sore foot, using crutches or a frame as you were shown. Your ankle may be in a plaster or a removable boot to protect it while it settles. Your physiotherapist will guide you through exercises as your recovery progresses. These usually start gently and build up as movement returns and the swelling settles. Day by day, you will notice small gains: standing more comfortably, moving the ankle a little further, and managing more around the house.

Some milestones are easy to recognise. Once your surgeon clears you to put weight on the foot, walking gets steadily easier. When the swelling has settled and you can move the ankle confidently, everyday activities feel normal again. If driving is relevant for you, the general rules apply: no driving while your ankle is in a plaster, splint or boot, or while weight is being kept off it, and only drive when you are off strong pain medication and can move your foot between the pedals and brake hard without hesitating. A boot is not an exemption, and having the cast or boot taken off is not by itself the green light. Which ankle was operated on matters, and so does whether the car is automatic or manual: in an automatic the right foot does the braking, while in a manual the left foot works the clutch. Your own surgeon decides the timing.

Recovery varies from person to person. Your timeline may differ, and your surgeon and physiotherapist will guide you along the way.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Infection in the bone or joint after ankle surgery is uncommon but serious. It can cause a deep, throbbing pain that does not ease with simple painkillers, along with redness, warmth or fluid leaking from the wound. If you notice any of these signs, contact the clinic straight away or go to the emergency department.

The wound itself can sometimes break down, and the skin at the edge of the cut can die off. This shows up as darkened or pale skin near the wound, or a patch that will not heal. Mention it at your next review, or call the clinic sooner if the area looks worse.

A nerve on the outer side of the ankle can be irritated or injured during surgery. This causes numbness, tingling or a strange, altered feeling along the outside of the foot and ankle. Tell your surgeon about it at review, as these sensations often settle with time.

The metalwork holding the bone can occasionally cause problems. You might feel a lump, a rub or a click under the skin, or the screws may loosen and the bones shift slightly. If the metalwork keeps bothering you, it can be removed in a later operation. Raise it at your review appointment.

Sometimes the broken bone does not knit together as expected. This can cause ongoing pain or a feeling that the ankle is not solid when you stand on it. Your surgeon will pick this up on your x-rays and discuss the options with you.

A condition called complex regional pain syndrome can develop after surgery. It causes pain that seems out of proportion, with swelling, changes in skin colour and sensitivity that makes the foot hard to touch. Report it early, as treatment works best when started soon.

Children who break the outer ankle bone can go on to sprain the same ankle again later. If your child's ankle keeps giving way, bring it up at review.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Most problems give early warning signs. Call us if you have a fever, or the wound becomes more red, warm or starts leaking fluid. Call us if pain keeps getting worse instead of easing, or if your calf becomes swollen and tender. Go to emergency if you have shortness of breath, chest pain, sudden severe pain in the ankle, numbness or tingling that is new, or you cannot move your foot or toes at all. These signs need checking straight away. If you are ever unsure, call the clinic. We would rather hear about a small worry than miss a big one.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology¶

Bony Anatomy¶

The ankle joint is a three-bone joint where the body of the talus articulates with the tibial plafond superiorly and the medial malleolus medially [15].
The posterior malleolus is a dorsal projection of the tibia that enlarges the confluent articular area and serves as a constraint to posterior translation of the talus [15, 17].
The lateral articulation of the talus is with the distal fibula, which takes approximately 1/6th of the load during weight bearing [15].
The medial malleolus is shorter and more anterior than the lateral malleolus, resulting in a joint axis positioned in 15 degrees of external rotation [15].
The talus is shaped like a trapezoid that is wider in the anterior body than in the posterior body [17].
Dorsiflexion of the ankle widens the mortise as the fibula migrates proximally and externally rotates through the syndesmosis [17].
The fibula lies posterior to the central axis of the tibia in the sagittal plane within the concavity of the distal posterolateral tibia, known as the incisura [17].

Ligaments and Syndesmosis¶

The syndesmosis comprises the anterior-inferior tibiofibular ligament (AITFL), the posterior-inferior tibiofibular ligament (PITFL), and the interosseous ligament [15, 17].
The AITFL arises from the tubercle of Chaput on the anterolateral tibia and inserts onto an equivalent prominence on the fibula [15].
The PITFL attaches to the lateral aspect of the posterior malleolus [17].
The interosseous ligament is central between the tibia and fibula and is confluent with the interosseous membrane above [15, 17].
Medial ligamentous support of the tibiotalar joint is provided primarily by the deep deltoid ligament, which limits lateral translation and external rotation of the talus [17].
Disruption of the deep deltoid ligament in association with a lateral injury may result in an unstable tibiotalar joint [17].

Pathophysiology and Injury Mechanisms¶

Ankle fractures are typically low-energy injuries with the majority occurring due to simple falls or sport [15].
High-energy mechanisms indicate the likelihood of additional soft tissue complications, compartment syndrome, pilon fractures, or other associated injuries [2].
The Lauge-Hansen classification system is based on cadaver work identifying common fracture patterns based on the position of the foot and direction of force applied at the time of injury [8].
Supination-adduction fractures are produced by tension failure of the fibula and axial loading of the medial plafond, resulting in a vertical medial malleolar fracture [8].
Medial tibial plafond impaction occurs in up to 50% of supination-adduction injuries and must be addressed [10].
The posterior pilon fracture variant is usually associated with a posterior tibiotalar dislocation and a characteristic posterior malleolar fracture extending from the PITFL origin laterally to the medial malleolus [8].
The posterior pilon fracture variant produces a double contour of the medial malleolus on the AP radiograph [8].
Ankle fractures represent 10% of all fractures with an incidence of around 137/10⁵ population per year [15].
The mean age at injury for ankle fractures is 45 years [15].
Ankle injuries have a bimodal distribution with peak incidences in younger men and older women, separated by a 50-year gap [15].
Bimalleolar and trimalleolar ankle fractures do not have a bimodal distribution but instead show a type E distribution with a peak only in elderly women [15].
The microarchitecture of the trabecular bone in the distal tibia of elderly patients with ankle fractures is abnormal and depleted, suggesting these injuries should be considered true osteoporotic fractures [15].
Obesity is a risk factor for sustaining ankle fractures, with obese women over age 55 significantly more likely to sustain a fracture than nonobese women [15].
Obesity predisposes to more severe injury, with patients with unstable ankle fractures far more likely to be obese (29%) than those with stable fractures (4%) [15].
Alcohol use is a risk factor for ankle fractures, with 29% of patients in one series having consumed alcohol in the 4 hours preceding the fracture [15].
Diabetes indicates an increased likelihood of wound complications owing to immunologic and vascular impairment [2].
Poorly controlled diabetics are at risk of peripheral neuropathy, which may influence postoperative weight-bearing decisions [2].
Diabetic patients with comorbidities such as vasculopathy, neuropathy, or Charcot arthropathy have a higher risk of complications compared with diabetics without comorbidities [1].
Delayed fracture and wound healing, soft-tissue compromise, vasculopathy, and neuropathy are specific considerations in the treatment of diabetic ankle fractures [1].
Nonoperative treatment of displaced ankle fractures is associated with up to 21-fold increased odds of complications compared with operative intervention [1].
Concomitant intraarticular injuries such as syndesmosis disruption, ligament injury, and osteochondral lesions have been reported in up to 80% of patients with ankle fractures [6].
Osteochondral lesions were present in 26% of Weber B fractures, 24% of Weber C fractures, and 20% of isolated medial malleolar fractures [6].
Chondral lesions were identified in 78% of 116 patients with acute ankle fracture, with talar dome chondral lesions present in 43% [6].
Patients with complete syndesmosis disruption and instability were more likely to have chondral injury [6].
Patients younger than 30 were less likely to have a chondral injury [6].
Minimal displacement of the talus can lead to increased joint contact pressures and increased risk of posttraumatic arthritis [14].
Malreduction of the posterior malleolus is significantly more likely to lead to malreduction of the syndesmosis [22].
Open reduction and internal fixation of the posterior malleolus significantly reduced the rate of persistent syndesmotic instability requiring fixation compared to no treatment [21].
Syndesmosis malreduction was associated with a poorer clinical outcome in a study of 87 patients using comparison postoperative CT scans [7].
Isolated assessment of the injured ankle using fluoroscopy is unreliable for determining syndesmosis reduction accuracy [7].
A posteriorly placed clamp tine on the medial tibia was significantly more likely to lead to syndesmosis malreduction [7].
Bioabsorbable screws have higher rates of complications than metal screws, particularly foreign body reactions [7].
Planned screw removal has not been shown to be advantageous compared with retention and may lead to complications including infection, screw breakage, and recurrent diastasis [7].
Suture button fixation has been demonstrated to reduce rates of syndesmosis malreduction compared to screw fixation [20].
In one randomized study, the suture button group had a lower rate of malreduction and less pain at 2-year follow-up compared to the screw group [7].
In another randomized study, the screw fixation group had more than twice as many malreductions (39% versus 15%) and a higher rate of implant removal compared to the suture button group [7].
Osteoarthritis of the ankle is most commonly caused by trauma, with 39% of cases in a recent series found to be secondary to ankle fracture [19].
AO/OTA type C fracture patterns, high BMI, dislocation, and increased age are risk factors for the development of posttraumatic osteoarthritis [19].
Cartilage damage was a predictor of posttraumatic osteoarthritis at a mean of almost 13 years follow-up [19].
Worse outcomes were found with deeper cartilage lesions and those located on the anterior or lateral talus or the medial malleolus [19].
The mean time from ankle fracture to end-stage osteoarthritis was 21 years [19].
Wound infection rates of up to 32% have been reported in diabetic patients with ankle fractures [19].
Osteoarthritis may occur in up to 30% of unstable ankle fracture patterns [19].
Loss of reduction is most common in conservatively treated, unstable fractures [19].
Nonunion is most commonly encountered after nonoperative treatment of ankle fractures [19].
Compartment syndrome is rare and associated with high-energy fractures [19].
The superficial peroneal, sural, and saphenous nerves are at risk in the subcutaneous layer during ankle fracture surgery, potentially resulting in neuroma [19].
In pediatric ankle fractures, inversion injuries typically result in distal fibular physeal fractures, almost exclusively Salter-Harris type I or II [5].
Tillaux fractures are Salter-Harris type III fractures of the anterolateral tibial epiphysis that occur with supination–external rotation injuries [5].
Triplane fractures are Salter-Harris type IV fractures that include an anterolateral fragment of the distal tibial epiphysis in conjunction with a metaphyseal fracture [5].
Medial malleolar Salter-Harris type IV shear ankle fractures have the highest risk of growth arrest [5].
Joint incongruity and late osteoarthritis are risks with distal tibial Salter-Harris type III and IV fractures [5].
Complex regional pain syndrome is relatively common in children following ankle fractures [5].

Clinical Presentation¶

History and Mechanism¶

Assessment of an ankle fracture requires a detailed history, a thorough physical examination, and radiographic imaging [2].
High-energy mechanisms indicate the likelihood of additional soft tissue complications, compartment syndrome, the presence of the more complex pilon fracture, or other associated injuries [2].
A history of smoking, alcohol abuse, and psychiatric illness increases the likelihood of complications [2].
The increasing prevalence of diabetes results in surgeons treating more diabetic ankle fractures each year [1].
Diabetic patients present a unique clinical challenge due to increased risk of complications, regardless of surgical or nonsurgical treatment [1].

Physical Examination¶

Clinical examination begins with inspection for deformity, bruising, blistering, skin integrity, and color [2].
Palpation of the limb starts at the fibular head and progresses sequentially down the lateral aspect of the leg to the lateral malleolus and the soft tissues anterior and posterior to it [2].
Palpation then moves medially across the ankle joint to the medial malleolus and its adjacent soft tissue structures [2].
Palpation of the skeleton of the foot excludes commonly associated or missed injuries such as fractures of the metatarsals or lateral talar process, or disruption of the midtarsal (Lisfranc) articulation [2].
Palpation of the Achilles tendon and the Simmonds or Thompson's test exclude rupture of this structure [2].
A distal neurovascular assessment includes assessment of temperature and capillary refill [2].
Skin marking of palpable dorsalis pedis and posterior tibial arterial pulsations at presentation is helpful in later assessment if the condition of the limb deteriorates [2].
A thorough neurologic and vascular history and examination is required when evaluating diabetic patients with ankle fractures [1].
Monofilament examination should be performed on diabetic patients to assess for the presence of sensory neuropathy [1].
Patients with diminished or absent pulses warrant additional workup and potential intervention with a vascular consultation to optimize outcomes [1].

Diagnostic Criteria¶

The Ottawa ankle rules provide assistance in determining the need for x-ray [2].
The Ottawa ankle rules offer a highly sensitive and cost-effective method of identifying patients presenting with ankle injuries that are most likely to have sustained a fracture [2].
The applicability of the Ottawa ankle rules in certain patient groups such as diabetics has been questioned [2].
Pain exists near one or both of the malleoli plus one or more of the following: age >55 years old, inability to bear weight, or bone tenderness over the posterior edge or the tip of either malleolus [2].

Comorbidity Considerations¶

Diabetic patients with comorbidities (vasculopathy, neuropathy, Charcot arthropathy) have a higher risk of complications compared with diabetics without comorbidities [1].
Delayed fracture and wound healing, soft-tissue compromise, vasculopathy, and neuropathy need to be considered when formulating a treatment plan for diabetic ankle fractures [1].

Investigations¶

Clinical Assessment¶

High-energy mechanisms of injury indicate the likelihood of additional soft tissue complications, compartment syndrome, pilon fractures, or other associated injuries [2].
Diabetes requires preoperative work-up and perioperative blood sugar management and indicates an increased likelihood of wound complications owing to immunologic and vascular impairment [2].
The Ottawa ankle rules provide a highly sensitive and cost-effective method of identifying patients with ankle injuries most likely to have sustained a fracture [2].
The initial assessment of a patient with an ankle fracture includes an evaluation of the soft-tissue envelope and neurovascular status [8].
A carefully documented motor and sensory examination should be performed during initial assessment [8].

Radiography¶

The three standard radiographs for ankle trauma are an anteroposterior (AP), a lateral, and a mortise projection [3].
A mortise view of the ankle taken in 15 degrees of internal rotation is helpful in assessing the lateral aspect of the ankle, which is often poorly seen on the AP view due to the frustal shape of the talus and overlap of the tibia, fibula, and talus [3].
Tenderness of the proximal fibula should be investigated with a full-length radiograph of the leg [3].
Interpretation of ankle radiographs follows the sequence ABCS, including assessment of technical adequacy, alignment, cortical outline, trabecular morphology, articular margins, and soft tissue contour [3].
The medial clear space should be less than 5 mm and no more than 2 mm greater than the tibiotalar clear space [3].
The tibiofibular clear space (syndesmosis A) 10 mm above the joint line should be greater than 5 mm [3].
The tibiofibular overlap (syndesmosis B) 10 mm above the joint line should be less than 5 mm on the AP view and less than 1 mm on the mortise view [3].
The articular margins of the distal fibula and the lateral process of the talus on the mortise view should be parallel and equal to the tibiotalar joint space, a confirmatory visual cue known as the "ball sign" [3].
The talocrural angle is approximately 83 degrees and should be symmetrical with the contralateral ankle [3].
Medial malleolus displacement should be less than 2 mm [3].
Lateral malleolus displacement should be less than 2 mm shortening, or displacement posteriorly or proximally [3].
Posterior malleolus displacement is considered abnormal if the fragment is greater than 25% of the ankle joint seen on the lateral radiograph or greater than 2 mm displaced [3].
The size of the medial clear space more than doubles depending upon the rotational position of the limb [3].
There is a significant increase in medial clear space with ankle plantarflexion [3].
The accuracy of plain radiographic measurements has been questioned in light of CT studies showing that assumptions based on two-dimensional radiographs are not always accurate [3].
Comparison views of the contralateral side are occasionally helpful due to substantial variability in normal anatomy between individuals [3].
AP, mortise, and lateral radiographs are often sufficient to identify the fracture pattern [10].
External rotation stress or gravity stress radiographs assess for deltoid integrity [10].
Medial clear space widening with stress indicates deep deltoid disruption and implies an unstable fracture pattern [10].
The medial clear space is typically less than 4 mm [10].
The talocrural angle is 83 (±4) degrees [10].
Talar tilt should be less than 2 mm [10].
Measurements for syndesmotic issues are made at 10 mm above the plafond [10].
The tibiofibular clear space is less than 6 mm on AP and mortise views [10].
Abnormality of the tibiofibular clear space is most predictive of syndesmotic disruption [10].
Tibiofibular overlap should be less than 6 mm on the AP view and less than 1 mm on the mortise view [10].
Tibiofibular overlap should be less than 10 mm or 42% the width of the fibula [10].
A continuous curve along the lateral talus and tip of the distal fibula is known as the Shenton line or dime sign [10].
The ankle fracture spur sign at the inferomedial tibial metaphysis is indicative of a hyperflexion variant injury [10].
After reduction of an injury with an ankle fracture spur sign, a CT scan should be obtained to evaluate the articular surface more clearly [10].
The medial clear space between the medial shoulder of the talar body and medial malleolus is typically less than 5 mm on AP and mortise radiographic views [9].
The tibiofibular clear space between the medial border of the distal fibula and the medial incisura typically measures less than 6 mm on the AP and mortise views [9].
Comparison radiographs of the contralateral limb are particularly useful to identify whether an accurate reduction of fibular length, rotation, and/or the syndesmosis has been obtained [9].
Weight-bearing radiographs can simulate the gravity and external rotation stress tests to determine tibiotalar instability in the setting of an isolated fibula fracture [9].
Ultrasonography may be effective and potentially less painful for the patient when evaluating deltoid integrity [9].

Advanced Imaging¶

A CT scan allows evaluation of the orientation of the fracture line, location of the fracture apex, size of the fragment, associated impaction, and presence of medial extension for posterior malleolar fragments [9].
CT can identify impaction of the articular surface in injuries involving axial load, which is especially prevalent in supination-adduction type injuries [9].
CT can evaluate the syndesmosis, including the shape and depth of the incisura, debris that may block a reduction, and small avulsion fractures of the anterior-inferior tibiofibular ligament or posterior-inferior tibiofibular ligament [9].
Some authors have described obtaining a CT scan of both ankles in the presence of a syndesmosis injury to identify normal anatomy due to significant variability in the width and congruence of the incisura-fibula relationship [9].
Fractures with a posterior malleolar component or fracture/dislocations are best evaluated with a CT scan to assess for the presence and displacement of articular fragments [10].
The severity of posterior malleolar fractures on plain radiographs can be underestimated in comparison with appearance on CT scans [10].
Review of CT scans for posterior malleolar fractures often alters the operative approach [10].
A 2014 study concluded that MRI was unnecessary for supination-external rotation injuries, displaying a lower interobserver reliability compared with external rotation stress [9].
Arthroscopy has been found to be more sensitive than MRI and stress radiographs of the syndesmosis in detecting instability [6].
A cadaver study showed that stress radiographs were inadequate in distinguishing between an intact ligament and a single disrupted ligament, whereas arthroscopy better demonstrated an isolated ligament disruption [6].
Arthroscopic evaluation of the joint before fixation can detect chondral injuries and latent syndesmosis injuries [6].
Chondral lesions were identified in 78% of 116 patients with acute ankle fracture, and talar dome chondral lesions were present in 43% [6].
All patients with dislocations had a chondral lesion [6].
Concomitant intraarticular injuries have been reported in up to 80% of patients with ankle fractures [6].

Syndesmotic Assessment¶

The syndesmosis must be evaluated, and reduction and stabilization should be performed when instability exists [7].
True instability at the distal tibiofibular joint should be distinguished from isolated medial clear space widening, which can occur with an untreated deltoid ligament injury [7].
It is critical to assess for sagittal (anterior-to-posterior) instability and/or a sagittal plane malreduction of the syndesmosis [7].
Preoperative AP and lateral images of the contralateral ankle are used to assess normal tibiofibular clear space and anterior-to-posterior position of the fibula [7].
If the tibiofibular clear space widens compared with the normal ankle during stress testing, there is likely some degree of syndesmosis injury [7].
If only the medial clear space widens during stress testing, the deltoid ligament is injured [7].
In the setting of a medial malleolar fracture, an isolated deltoid ligament injury is rare [7].
Radiographic comparison of the contralateral extremity, intraoperative or postoperative CT scan, or direct visualization of the confluence of the distal tibia, fibula, and talus are potentially more reliable options for assessing syndesmosis reduction [7].
A larger study of 87 patients found that syndesmosis malreduction was associated with a poorer clinical outcome [7].
One recent study of 48 patients was unable to detect a difference in functional outcomes based on reduction quality [7].
A posteriorly placed clamp tine was significantly more likely to lead to syndesmosis malreduction [7].
The axial view of the CT scan can be used to visualize the axis of reduction, plan tine placement, and identify the shape of the incisura [7].

Pediatric Considerations¶

Ankle fractures represent around 5% of all pediatric fractures and 15% to 20% of all physeal injuries [5].
Ankle fractures are considered the most common physeal fractures of the lower extremity [5].
Inversion ankle injuries in children typically result in distal fibular physeal fractures, almost exclusively Salter-Harris type I or II [5].
MRI studies do not show physeal injuries of the distal fibula in children with inversion injuries, questioning the dogma that these fractures are more common than ankle sprains [5].
Salter type I fractures are diagnosed clinically by tenderness at the level of the physis and radiographs that show no malalignment of the physis and soft-tissue swelling over the distal fibula [5].
CT should be obtained after casting for triplane fractures to confirm that reduction is satisfactory, defined as less than 2 to 3 mm of fracture diastasis and articular step-off [5].
Postreduction CT should show less than 2 to 3 mm of displacement (fracture diastasis or articular step-off) for Salter-Harris type III fractures [5].
Growth arrest with angular deformity and/or leg length discrepancy is minimized by reduction within 2 mm of anatomic [5].
Complex regional pain syndrome is relatively common in children following ankle fractures and should be suspected in children who do not show prompt resolution of pain following immobilization [5].

References¶

[1] Aaos Comprehensive Orthopaedic Review 3. The Diabetic Foot and Ankle > V. Diabetic Ankle Fractures.

[2] Rockwood And Green S Fractures In Adults. 59: Patellar Fractures and Dislocations and Extensor Mechanism Injuries > Clinical Assessment of Ankle Fractures.

[3] Rockwood And Green S Fractures In Adults. 59: Patellar Fractures and Dislocations and Extensor Mechanism Injuries > Imaging and Other Diagnostic Studies for Ankle Fractures > Radiography.

[5] Aaos Comprehensive Orthopaedic Review 3. Pediatric Pelvic and Lower Extremity Fractures > VIII. Ankle Fractures.

[6] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC EXAMINATION AND DEBRIDEMENT OF THE ANKLE JOINT > ANKLE FRACTURES.

[7] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Syndesmosis Injury.

[8] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Initial Assessment and Classification.

[9] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Imaging.

[10] Miller S Review Of Orthopaedics. ANKLE FRACTURES.

[14] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Management.

[15] Rockwood And Green S Fractures In Adults. 59: Patellar Fractures and Dislocations and Extensor Mechanism Injuries > Introduction to Ankle Fractures.

[17] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Ankle Anatomy.

[19] Rockwood And Green S Fractures In Adults. 59: Patellar Fractures and Dislocations and Extensor Mechanism Injuries > Management of Adverse Outcomes and Unexpected Complications in Ankle Fractures.

[20] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Summary.

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