ANKLE FRACTURES AND FRACTURE- DISLOCATION. Fractures and fracture-dislocation of the ankle are common. Mechanisms ; twisting slipping. The injury may be caused by direct trauma.

CLASSIFICATION. Fractures of the ankle can be classified according to ;  Mechanism of injury. The Lauge-Hansen classification. This classification is very complex.  Anatomical. The relation of the fracture of the fibula to the syndesmosis ; Weber A, Weber B and Weber C.

CLINICAL FEATURES.  History of twisting the ankle.  Clinically the ankle is swollen, deformed ( if there is fracture-dislocation), and tender.  Identify areas of tenderness because they are a clue to the diagnosis and treatment.  Commonly closed injuries.

INVESTIGATIONS. A fracture-dislocation of an ankle is a clinical diagnosis. The dislocation must be reduced and the ankle immobilized before sending patient to X-rays. You must request three X-rays ; AP, LATERAL AND OBLIQUE. Each X-ray film must include the ankle and knee joints.

PRINCIPLES OF TREATMENT.  Reduce fracture-dislocations urgently.  Always splint the ankle.  Elevate the ankle to decrease swelling.  We operate all ankle fractures except those with a minimally displaced lateral malleolus with no medial tenderness.  Fracture of an ankle unites in six weeks.

COMPLICATIONS. EARLY ;  Skin breakdown esp. In fracture-dislocation.  Vascular damage.  Swelling plus blisters.

COMPLICATIONS …….. Late ;  Malunion.  Non-union.  Joint stiffness.  Osteo-arthritis.  Complex regional pain syndrome.  THE END.