Overview of ankle fractures in adults
- Scott M Koehler, MD
Scott M Koehler, MD
- Physician, Sports Medicine Specialist
- Allina Medical Clinic, Northfield
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Ankle fractures are increasingly common injuries that necessitate a careful approach for proper management. Over five million ankle injuries occur each year in the United States alone .
This topic review will provide an overview of ankle fractures that result from minor trauma (ie, indirect or low energy fractures), including a basic approach to their evaluation and management. Fibular fractures above the lateral malleolus, tibial fractures, and ankle injuries other than fractures are discussed elsewhere. (See "Fibula fractures" and "Overview of tibial fractures in adults" and "Ankle sprain" and "Non-Achilles ankle tendinopathy".)
EPIDEMIOLOGY AND RISK FACTORS
The incidence of ankle fractures is approximately 187 fractures per 100,000 people each year . Since the mid-1900s, this rate has increased significantly in many industrialized countries, most likely due to growth in the number of people involved in athletics and in the size of the elderly population [1-3].
The vast majority of ankle fractures are malleolar fractures: 60 to 70 percent occur as unimalleolar fractures, 15 to 20 percent as bimalleolar fractures, and 7 to 12 percent as trimalleolar fractures [1,4]. There are similar fracture rates overall between women and men, but men have a higher rate as young adults, while women have higher rates in the 50 to 70-year age group [1,4].
Cigarette smoking and a high body mass index have been associated with ankle fractures [5,6]. In contrast to fractures of the radius and other fractures common among perimenopausal and postmenopausal women, bone density has not been clearly demonstrated to be a major risk factor .
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- Malleolar fractures
- CLINICAL PRESENTATION AND EXAMINATION
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- Initial treatment
- Management of specific malleolar fractures
- - Lateral malleolar fractures
- - Isolated medial or posterior malleolar fractures
- - Lateral malleolar fractures with deltoid ligament injury
- - Bimalleolar and trimalleolar fractures
- REHABILITATION AFTER ANKLE FRACTURE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS