The Ottawa ankle rules recommend radiography if there is bony tenderness along the posterior edge of fibula or tip of the lateral or medial malleolus, at the base of the 5th metatarsal bone, at the navicular bone, or if there is inability to bear weight both immediately after injury and for 4 steps during initial evaluation. X-rays of the patient’s left ankle revealed a transverse fracture of the lateral malleolus ( Figure 1).Īnkle fractures are easily diagnosed with plain radiography. The dorsalis pedis pulse was intact, and there were no open wounds. There was no tenderness to the base of the 5 th metatarsal, or over the fibular head. A focused physical examination showed tenderness and edema near over the posterior edge of left lateral malleolus. Her vital signs were: temperature 36.4 0C, blood pressure 129/81 mmHg, respiratory rate of 19 breaths per minute, heart rate of 97 beats per minute, oxygen saturation of 100% on room air. She denied any smoking, recreational drug or alcohol use. The patient had no significant past medical or surgical history, and no known allergies. Review of systems was otherwise negative. The patient also endorsed that the pain worsened with palpation and improved with rest. The patient claimed that the pain and swelling began immediately afterwards but that she did not experience numbness, tingling, or weakness. The patient stated that she was walking out of her home with two steps when she tripped and fell, causing an inversion injury to her left foot. In this paper, we discuss a case in which a patient presented with a nondisplaced lateral malleolar fracture and the treatment that followed.Ī 35 year old female presented to the emergency department (ED) via emergency medical services (EMS) with left ankle injury and swelling at the injury site. 5 The fracture will take anywhere between 2-12 weeks to heal, so continual inspection is advised. 4 For example, in Weber-B patients, intramedullary nails are preferred over locking plates for their consistently superior results. This consists of either interlocking intramedullary nails or an anatomical locking plate. In cases where diastasis is evident, surgery may be required. For Danis-Weber Type A, once the bone is aligned and the ankle secured, a splint, cast or boot is recommended to maintain immobilization during healing, followed up with exercises to maintain muscle activity. The treatment plan depends on the severity of the fracture. There is usually widening of the distal tibiofibular articulation and medial malleolus fracture or deltoid ligament injury may be present. A Danis-Weber Type C fracture is always unstable and occurs proximal to the level of the syndesmosis. The medial malleolus may be fractured or deltoid ligament may be torn. The tibiofibular syndesmosis is usually intact or only partially torn, but there is no widening of the distal tibiofibular articulation. A Danis-Weber Type B is a fracture at the level of the syndesmosis and has variable stability.
The fracture is generally below the level of the tibial plafond, with an intact syndesmosis and deltoid ligament. 3 A Danis-Weber Type A is a fracture of the lateral malleolus distal to the syndesmosis and is usually stable unless there is also a medial malleolar fracture. The Danis-Weber classification grades the ankle fracture based on the location of distal fibular fracture as compared to the syndesmosis. Patients will almost always report moderate to severe pain and a possible inability to walk or apply pressure on the site of injury. 1,2Īnkle fractures can occur after a fall, twist, or direct hit to the bone. 1 Not surprisingly, there is a bimodal distribution with a peak during the years of 15-24, particularly in males, and then again between the ages 75 and above, when falls become more prominent, and osteoporosis sets in, particularly in women. Ankle fractures are common emergency department presentations, with an incidence of 187 per 100,000.
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