Ankle Fractures

Malleolar fractures of the ankle are the most frequent traumatic pathology of the lower limbs, affecting the distal portion of the fibula and tibia. The tibiofibular mortise is one of the most congruent joints, and this characteristic will be affected not only by bone injury but also by ligament injury that is an important part of its stability. There are several classification methods for ankle fractures. The most used classification systems include the Lauge–Hansen classification, the Weber classification, and the AO classification. Ankle fractures clinical presentation generally includes swelling, deformity, and inability to bear weight, depending on the energy of the trauma. The standard series to be ordered in case of ankle trauma are three radiographic views: the anteroposterior (AP) view of the ankle, the AP view of the mortise, and the lateral X-ray. When surgical treatment is considered, the authors prefer minimally invasive techniques in fractures without comminution and minimal rotation or shortening. In trimalleolar fracture patterns, or in cases with associated avulsion fractures of the posterior malleolus, the authors prefer to reduce and perform osteosynthesis ofin the fibula first and then fix the posterior malleolus. The main controversies remain in the fixation of the syndesmosis, the size and number of screws to be used, the number of cortices engaged (in the syndesmosis), the time when the weight bearing is started, and whether to remove or retain syndesmotic screws.