Ankle fracture
Ankle fracture is confirmed on AP, mortise, and lateral radiographs obtained when the Ottawa ankle rules are positive, and management is dictated by displacement and stability: nondisplaced fractures are casted while displaced or unstable fractures require reduction and, if reduction fails or the fracture is severely displaced, operative fixation.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
An ankle fracture is a break in one or more of the malleoli (medial, lateral, or posterior) or the distal tibial or fibular articular surface, most often produced by a rotational (twisting) force…
- Epidemiology
Common across the age spectrum: ankle fractures account for about 5% of all pediatric fractures and are more common in males (roughly 2:1), usually occurring between ages 8 and 15; they also occur…
- Risk factors
Sports participation, particularly cutting and jumping sports: raises the risk of the rotational twisting mechanism that produces most ankle fractures in younger, active patients.
- Pathophysiology
Rotational (twisting) mechanism: a planted foot combined with rotation of the leg transmits shear and rotational force through the ankle mortise, fracturing the lateral malleolus (fibula), medial…
- Clinical features
Acute ankle injury (twisting mechanism or direct trauma) with focal bony tenderness over the medial or lateral malleolus, most pronounced at the posterior margin: the hallmark finding that distinguishes fracture from sprain at the bedside.
- Differential diagnosis
Ankle sprain: accounts for the majority of ankle injuries; unlike fracture, patients are typically able to bear weight despite pain, and radiographs, when obtained, show no fracture line because only ligaments are stretched or torn.
- Diagnosis
Ankle fracture is confirmed by AP, mortise, and lateral ankle radiographs obtained when the Ottawa ankle rules are positive: bone tenderness at the posterior edge or tip of the lateral or medial…
- Management
First, assess for open fracture, neurovascular compromise, or gross deformity requiring emergent reduction, since these findings change management urgency regardless of the definitive fixation plan…
- Complications
Post-traumatic ankle degeneration (osteoarthritis): the leading long-term complication, driven by residual joint incongruity from inadequately reduced or unstable fractures.
- Prognosis
Nondisplaced fractures treated with immobilization alone generally heal well with a low complication rate.
- Prevention
Ankle bracing or taping during high-risk sports (basketball, soccer) in athletes with prior ankle injury reduces the risk of a repeat traumatic mechanism, extending the same injury-prevention principle used for ankle sprain.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Ankle sprain
Ankle sprain is a clinical diagnosis from an inversion injury with lateral ligament tenderness, graded by severity, and the Ottawa ankle rules determine which patients need radiographs to exclude fracture before starting conservative treatment.
- Extremity fractures
Extremity fractures are diagnosed by focal bony tenderness, deformity, or inability to bear weight/load confirmed on radiograph, and are triaged first for life- and limb-threatening features (hemorrhage, open injury, vascular compromise, compartment syndrome) before definitive fixation decisions. Open fractures need immediate antibiotics and operative debridement, and unstable or displaced patterns need surgical fixation, while stable nondisplaced fractures are managed with reduction and immobilization.
- Achilles tendon rupture
Achilles tendon rupture presents with a sudden pop in the calf and a positive Thompson test, and is treated with either operative repair or functional bracing, both followed by early functional rehabilitation.
- Stress fracture
Stress fracture is a bone injury from repetitive submaximal load that outpaces bone remodeling, most often in the foot or tibia in runners, and management is dictated by the anatomic site's nonunion risk rather than by pain alone.
- Osteomyelitis
Osteomyelitis is bone infection from hematogenous seeding or contiguous spread, most often from Staphylococcus aureus, presenting as subacute pain with or without a draining sinus tract and confirmed by bone biopsy culture. Empiric antibiotics are withheld until biopsy in a stable patient, and treatment combines source control with 4 to 6 weeks of culture-directed antibiotics, extended to 6 weeks or indefinite suppression for hardware-associated or chronic disease.