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“Ankle fracture”. This is how most people describe one of the most common acute injuries in the joints, although the term is anything but accurate. This is because the fractures relate to the two “ankles”, the outer and the inner, which are, in fact, the ends of the of the tibia and the fibula, which hold the ankle together through the joint, during walking.
Orthopaedists classify the lesions according to which bone is involved. The lateral malleolus is the lower end of the fibula, the medial malleolus is the lower end of the tibia, and the medial malleolar sulcus is the posterior rim of the distal part of the tibia. Thus, accordingly, the classification is divided in individual fractures, of the lateral malleolus, or of the medial malleolus, in fractures of both malleoli (unimalleolar), which are the most frequent, or even the trimalleolar fractures.

According to the global epidemiological data, the dislocation of the articular surface and the transfer of body weight upon the ankle, namely the fractures of the malleoli, are the most frequent after those of the lower end of the radius in the radiocarpal joint. High-risk groups include young men, especially those who practice sports, and middle-aged women.
The most common injury mechanisms are the abrupt turning of the ankle and the foot, and traffic accidents. The clinical picture includes pain in the fracture area, extensive swelling, sensitivity upon palpation, deformity, and inability to walk. Simple x-rays will show the extent of the damage, while a CT scan is only required for complex fractures.

Given that there is a joint disorder, it is essential to make a correct reduction, in order to reduce the risk of future arthritis. Conservative treatment is followed in steadily non-displaced fractures (mostly of the lateral malleolus), and consists in the placing of a special corset or short leg plaster dressing for 6 to 8 weeks, depending on the type of fracture and the healing progress.
Broadly, the treatment depends on the height at which the lesion is located, and whether there is a dislocation or not, however, the unimalleoral and trimalleolar fractures are generally treated surgically. During surgery, an open reduction and an internal osteosynthesis of the lateral malleolus, with a plate and screws, and of the medial malleolus, with two screws or a screw and a metal needle are performed. In case of a complete tear of the tibiofibular syndesmosis, a screw holding the two bones holding (syndesmosis screw) is placed, which is removed after 6 weeks.
The patient’s post-operative course depends on the degree and extent of the lesion, but at least 6 weeks are required for the fracture to heal, a period that increases if concomitant diseases (e.g. diabetes mellitus) and lesions in ligaments and tendons are observed. A physiotherapist also plays an important role in the recovery process, since, the strengthening exercises are extremely important, in order for the patient to be able to walk without a crutch, as soon as possible. However, it is equally important to load the operated extremity when the orthopaedist approves, in order for a new injury to be avoided.
The most common complications in the fractures of the malleoli are healing in a malunion, resulting in the development of post-traumatic arthritis, the appearance of necrotic vesicles in the skin (Chassegnaque bubbles), joint stiffness due to its immobilization, and the appearance of Sudeck’s syndrome, which is mainly characterized by swelling and severe pain in the ankle and foot.

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