Fractures of the ankle joint: investigation and treatment options

• Published in: Deutsches Ärzteblatt international 2014-05, Vol.111 (21), p.377-388
• Main Authors: Goost, Hans, Wimmer, Matthias D, Barg, Alexej, Kabir, Kouroush, Valderrabano, Victor, Burger, Christof
• Format: Article
• Language: English
• Subjects: Ankle Fractures - diagnosis; Ankle Fractures - therapy; Combined Modality Therapy; Continuing Medical Education; Diagnostic Imaging - methods; Foot Orthoses; Fracture Fixation - instrumentation; Fracture Fixation - methods; Humans; Physical Examination - methods; Physical Therapy Modalities; Severity of Illness Index
• ISSN: 1866-0452
• DOI: 10.3238/arztebl.2014.0377

Ankle fractures are common, with an incidence of up to 174 cases per 100 000 adults per year. Their correct classification and treatment are of decisive importance for clinical outcome. Selective review of the literature. Ankle fractures are initially evaluated by physical examination and then by x-ray. They can be classified according to either the AO Foundation (Association for the Study of Internal Fixation) or the Weber classification. Dislocated fractures need emergency treatment with immediate reduction; this is crucial for the prevention of hypoperfusion and nerve damage. Weber A fractures can usually be treated conservatively, while Weber B and C fractures are usually treated with surgery. An evaluation of the stability of the syndesmosis is important for anatomical reconstruction of the joint. Wound hematoma and wound-edge necrosis are the most common complications, and the postoperative infection rate is 2%. Up to 10% of patients develop ankle arthrosis over the intermediate or long term. With properly chosen treatment, a good clinical outcome can be achieved. The long-term objective is to prevent post-traumatic ankle arthrosis. The evidence level for optimal treatment strategies is low.