Anatomy of the Ankle Joint

Compression Fracture

• Takes approximately 4 months to heal
• Around 75% of patients do well without wound complications
• 10% risk of requiring ankle arthrodesis

Paediatric Ankle Fracture

• Salter Harris fractures are common
• Avoid injury to physis
• May use K-wires or cannulated screws to reduce physis injury
• Triplaner fracture requires CT scan
• Talus fracture is rare

Talus Fracture

• Talar neck fractures are high-energy injuries
• High incidence of talus avascular necrosis
• CT scan is usually required
• May associate with talus dislocation
• Treatment involves reduction and fixation

Talar Body Fracture

• Rare
• May be lateral process, posterior process, or talar head fracture
• Diagnosis involves X-ray and CT scan
• Treatment is usually non-operative unless the fracture is displaced or intra-articular

Achilles Tendon Rupture

• Common tendon injury
• Mechanism: Sudden dorsiflexion, often in sports
• Typically occurs in males aged 30-40
• Rupture usually occurs 4-6 cm above the insertion
• History: Patient feels a "pop" and experiences weakness and pain with weight-bearing
• Signs: Swelling, ecchymosis, tenderness, and positive anterior drawer test and talar tilt test
• Investigation: X-ray, stress views, and MRI
• Treatment: Non-operative or operative, depending on pain and instability

Ankle Fractures

• Very common
• Usually due to twisting injury
• Affect all ages
• Types: Isolated malleolus (70%), bimalleolar (20%), and trimalleolar (7%)
• Weber (Danis-Weber) classification:
  • Type A: Below syndesmosis
  • Type B: Trans syndesmosis
  • Type C: Above syndesmosis
• Biomechanics: Deltoid ligament is primary restraint to talar shift, and fibula acts as buttress to prevent lateral talar shift
• Presentation: Symptoms and signs of pain, swelling, and deformity
• Investigation: X-ray, CT scan, and MRI
• Treatment: Non-operative or operative, depending on the severity of the fracture
• Outcome: Over 90% success rate, but full recovery may take a long time

Pilon Fracture

• Combination of ankle fracture and distal tibia fracture
• High-energy injury
• Significant associated soft tissue injury
• Around 25% are open fractures
• Mechanism: Vertical compression

Ankle Joint

• Bones: Tibial plafond, medial malleolus, lateral malleolus, and talus
• Motion: Plantar flexion, dorsiflexion, inversion, eversion, and rotation
• Ligaments: Medial, deltoid, lateral, anterior talofibular, posterior talofibular, calcaneal fibular, and lateral talocalcaneal

Distal Tibiofibular Joint

• Bones: Distal fibula and incisura fibularis
• Motion: Rotation during gait
• Ligaments: Syndesmosis, anterior inferior tibiofibular, posterior inferior tibiofibular, transverse tibiofibular, and interosseous

Ankle Sprain

• Very common
• Twisting injury
• Diagnosis: Clinical
• Treatment: Usually conservative
• Mechanism: Inversion injury in plantarflexed ankle
• High ankle sprain (syndesmosis injury) is less than 10% of ankle sprains
• Low ankle sprain (ATFL and CFL) is more than 90% of all ankle sprains
• Associated injuries: Osteochondral fractures, peroneal tendon injuries, and deltoid ligament injury