Ankle Fractures
Stability, syndesmosis, and fixation sequence.
Aug 15, 2026 · 3 refs
At a glance
Ankle fracture care is stability care. The question is whether the talus will stay reduced under the plafond through healing, not merely which malleoli are broken.
Read the mortise, stress when uncertain, and respect soft tissue. A perfect plate on a blistered ankle is the wrong win.
Classification
- Weber / Danis–Weber: fibula level relative to syndesmosis (A below, B at, C above)
- Lauge-Hansen: mechanism language useful for associated injuries
- Bimalleolar / trimalleolar / equivalents (deltoid incompetence can behave like a bimalleolar injury)
Decision-making
Stable, minimally displaced unimalleolar patterns may be non-op with close follow-up. Any suggestion of talar shift, unstable bimalleolar pattern, or syndesmotic instability pushes toward operative restoration of the mortise.
Reduce dislocations urgently. Temporary spanning external fixation belongs in the soft-tissue damage-control toolkit when the skin will not tolerate early ORIF.
Treatment
- Restore length, rotation, and alignment of the fibula; address medial clear space / deltoid as needed
- Fix the posterior malleolus when it contributes to stability or articular congruence
- Stress the syndesmosis after malleolar fixation; stabilize if incompetent
- Protect soft tissue; delay definitive fixation when blisters or massive swelling demand it
High-yield / exam
- Stability > number of malleoli
- Medial clear space and talar shift matter
- Syndesmosis testing after bony fixation
- Soft-tissue timing prevents wound disaster
Questions
Practice this Topic →- A Weber B fibula fracture has no talar shift on the injury mortise. Medial clear space looks borderline. Soft…Ortho Skills (Real Life)
- Danis–Weber C means the fibula fracture is:Boards
- A trimalleolar fracture-dislocation is reduced. The ankle is massively swollen with fracture blisters. The ne…Ortho Skills (Real Life)
References
- 01
Ankle fractures resulting from rotational injuries
Michelson JD · 1995 · Journal of the American Academy of Orthopaedic Surgeons · review
Frames ankle fractures as rotational stability problems.
- 02
Management of syndesmotic ankle injuries
2007 · Journal of the American Academy of Orthopaedic Surgeons · review
Syndesmotic competence is part of every unstable ankle plan.
- 03
OTA teaching resources on ankle fracture stability and fixation sequence
2020 · Orthopaedic Trauma Association · guideline
Emphasizes mortise restoration and soft-tissue timing.
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