Ankle fractures will present with pain and swelling of the ankle joint after an injury (fall, tripping down stairs, twisting injury during sports). This summary is an overview providing an initial approach for emergency medicine and primary care physicians. Subtypes (eg, medial malleolus fracture, posterior malleolus fracture, distal fibula fracture, bimalleolar and trimalleolar ankle fractures, talus fracture, pilon fracture, triplanar fracture) are discussed in more detail separately.

Patient recollection of the exact motion of the foot during the injury (supination, pronation, external rotation, internal rotation) often does not reliably correlate with the injury pattern seen on imaging or in the operating room. Therefore, the initial focus should be as follows:

• Get a basic history (eg, whether injury occurred during a fall from a height, sports activity, or car accident).
• Perform a thorough physical examination, including assessment for neurovascular deficit.
• Reduce the fracture if necessary (particularly if there is a neurovascular deficit).
• Evaluate x-rays for stability.

Risk factors for ankle fracture include obesity and smoking. Ankle fractures are not classic osteoporotic fractures (ie, bone density is not necessarily protective).

In most cases, patients will present immediately after an injury. Swelling can progress rapidly, and the degree of swelling has a major impact on the timing of surgery and can lead to complications.

Related topics: Ankle sprain, Dislocation of ankle, Syndesmosis injury