An official website of the United States government. No differences were found between the two groups with respect to age or American Society of Anesthesiologists status; however, there was a greater percentage of men in the syndesmotic injury group (P = 0.04). Only studies with outcomes scores were deliberately included to better compare results and to avoid vague or casual data. Ankle fractures are typically very painful and obvious if there is a dislocation (ankle joint out of place) or an open wound. government site. Results: Also, stiffness and post-traumatic osteoarthritis are reduced.2. The bones of the lower leg are the tibia and the fibula. The fracture pattern often provides useful clues not only regarding the mechanism of injury but whether there are associated lesions (that may not be apparent on the x-ray). A retrospective follow-up of ankle fracture patients treated with a biodegradable plate and screws. Federal government websites often end in .gov or .mil. Trimalleolar fracture is a specific injury in the ankle, where three areas known as the malleoli break simultaneously. The most standardized and reliable scores and questionnaires reported are the OMAS score, the AOFAS score, VAS score, and SMFA score.310 As far as the outcomes of the treatment of unstable ankle fractures are concerned, most studies reported excellent or good results with these scores.14,16,1821,2426,2934,39,43 Surgical fixation is mostly preferred over conservative treatment as it consistently returns better outcomes.7,13,17,26,32,38,42 Particularly, surgery allows for shorter immobilization and earlier weight-bearing leading to better functional scores and higher rates of return to normal life.19,26,34 As a result of this review, surgical treatment for all the unstable fractures is recommendable to restore the anatomy, function, and stability, and to reduce the risk of complications as post-traumatic arthritis was demonstrated to develop faster after conservative treatment.14,21,37,45, Interesting histological studies were performed by Tochigi and Quinn.46,47 The former demonstrated that post-traumatic osteoarthritis commonly occurred in multi-fragmentary fractures because of the death of chondrocytes near the fracture line.46 The cells disfunction propagates to the surrounding non-fracture areas within the first 48 hours, and its extent is related to the comminution degree, the overall length of the fracture lines, and to the intensity of the applied mechanical forces. This could mean a plate and screws, just screws, a nail, or just suture. Excellent and good results were 93.3%.18. Two-Stage Surgery for the Malleolar FractureDislocation With Severe Soft Tissue Injuries Does Not Affect the Functional Results. Stable fractures typically heal with immobilization and protected weight-bearing whereas operative management is usually required for displaced or unstable fractures. The ankle joint is formed of two lower leg bones, tibia on the inner side and fibula on the outer side. Lateral malleolus fractures are often stable and can be treated without surgery. Usually, the displacement of the posterior fragment is cranial, causing no mechanical impingement onto talar rotation during dorsal and plantar flexion (Figure 3). Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing. Complication rates following open reduction and internal fixation of ankle fractures. Verhage SM, Boot F, Schipper IB, Hoogendoorn JM. A prospective, randomized study of the management of severe ankle fractures. The fibular nail is an alternative method of fixation requiring a minimal incision and tissue dissection, and has the potential to reduce the incidence of complications. Lateral: Best for posterior malleolar fractures. Zhong S, Shen L, Zhao J guo, et al. Surgical treatment is preferable for unstable ankle fractures. Unstable ankle fracture: the stability or structure of the ankle joint is affected by the break. Your ankle surgeon uses metal plates and screws to stabilise your ankle to allow the bones to heal. Wang L, Shi ZM, Zhang CQ, Zeng BF. Initial locking screw constructs rendered between 91% (10 of 11) and 96% (23 of 24) of ankles stable. Irwin TA, Lien J, Kadakia AR. Accessibility Zhang L, Xu J, Tang X, Zhou X, Li B, Wang G. Front Bioeng Biotechnol. It is called a lateral (outside of the ankle) malleolus fracture and is depicted in Figure 5. Ankle fracture is defined as unstable when the integrity or stability are compromised: it occurs in case of disruption of the restraining structures on the medial side (deltoid ligament - medial malleolus), lateral side (lateral ligaments - fibular malleolus), distal tibiofibular syndesmosis and/or posterior malleolus (PM). When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. A stress x-ray is depicted in Figure 3B, and shows instability when compared to the image in Figure 3A. The stability related to posterior malleolus in ankle fracture. Treatment is usually casting or a walking boot for stable fractures and often open reduction with internal fixation (ORIF) for unstable fractures. A fracture may also damage your ligaments. Radiographically, 18 of 144 (13%) syndesmotic screws were noted to be broken on follow-up radiographs, eight of which were subsequently removed. Injury. Bethesda, MD 20894, Web Policies Please try again. eCollection 2019 Oct. Arch Orthop Trauma Surg. Outcomes of operative treatment of unstable ankle fractures: a comparison of metallic and biodegradable implants. Moreover, selecting the approach and hardware for the PM should be depending on the pattern of the fracture and on the surgeons preference and experience. Outcome of surgical management of bimalleolar fractures in adults. This site needs JavaScript to work properly. Thats why not jumping back into exercise too soon is essential. Indeed, during ankle motion and gait, the talar apex rotates posteriorly in dorsal flexion and anteriorly in plantar flexion, and forces are respectively transferred more anteriorly or posteriorly than the apex. Patients that incurred unstable ankle fractures and received surgical ORIF as treatment between January 2011 and August 2020 were reviewed retrospectively and included in this study. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. If you have diabetes, part of managing your condition means taking care of your feet. Concerning PM fractures, successful functional and radiological outcomes have been clearly demonstrated to be related to fixation.7,14,16,21,38,40,45 ORIF was traditionally indicated in case of fragment size greater than 25%-33% of the articular surface, measured on plain films or CT scans. An ankle injury happens whenever the ankle is rolled or twisted out of its normal position, resulting in pain and swelling. Schedule an appointment to see an Emory specialist today. Although fractured ankles are an injury seen in almost every age, it is becoming more prevalent in older, more active generations. Bookshelf The physical exam helps to determine the amount of laxity of the ankle joint, pain over the ankle, peroneal tendon pain/swelling, in addition the alignment of the . Since physical . HHS Vulnerability Disclosure, Help You can get an ankle injury doing almost any activity, but they more commonly result during sports and fitness activities, after tripping or falling, and when you twist your ankle during any activity. When you injure the ligaments in your ankle, you can end up with one of the three. In North America, most surgeons would agree that markedly unstable definitely unstable ankle fractures are best treated surgically.Therefore, Weber B . Kalem M, ahin E, Songr M, Keser S, Kinik H. Comparison of three posterior malleolar fixation methods in trimalleolar ankle fractures. Concerning unstable fractures of the ankle, Day described excellent or good outcomes in 64% of cases and fair or unsatisfactory in 36%.43. Widening of ankle mortise caused by syndesmosis injury leads to lateralization of vertical mechanic forces. Oblique (mortise) Best for evaluating for unstable fracture or soft tissue injury. Overall, surgeons should be considering the axis of the legs before choosing to surgically treat, and eventual causes for deformity should be investigated (rickets, neurofibromatosis, etc.). Surgical fixation of unstable ankle fractures should always be performed within the first 48 hours from the trauma, preventing instability and post-traumatic osteoarthritis. Distribution and progression of chondrocyte damage in a whole-organ model of human ankle intra-articular fracture. The deltoid ligament is found on the inner part of the ankle and provides the majority of the stability of the ankle. Scholastica Support. Complications associated with treatment were assessed and the frequency was reported. government site. The picture in Figure 4 shows a patient with a fractured ankle that is dislocated and pushing against (tenting) the skin. Theres no doubt having a sprained ankle is a pain! eCollection 2022. Validation of the American College of Foot and Ankle Surgeons Scoring Scales. ORIF has been demonstrated to be superior to conservative treatment: good short- or long-term results are reported, with several advantages including easier rehabilitation, early mobilization, and earlier weight-bearing. Kukk A, Nurmi JT. Injuries can result from anything from an unforeseen mis-step, to falling and rotating the ankle to the point of muscle strain, tendon tear, or bone break. In an unstable ankle fracture, the joint will not support weight-bearing without displacing. Nonsurgical Treatment A stable bimalleolar fracture may be treated with cast immobilization for several weeks. Typically these injuries are . Quinn TM, Huselmann HJ, Shintani N, Hunziker EB. 5 Surgeries Used to Treat Ankle Arthritis When part of this bone fractures, the ankle can become unstable. The most common ankle injuries are strains. VAS scale was reported in five studies, SMFA in two studies, while AFSS score, BairdJackson score, and Phillips score in one study. Comparison of Posteromedial Versus Posterolateral Approach for Posterior Malleolus Fixation in Trimalleolar Ankle Fractures. Untreated sprains can lead to a chronically unstable ankle joint. Articles were reviewed according to the Preferred Reported Items for Systematic Reviews and Meta-Analyses Statement for Individual Patient Data (PRISMA-IPD).11. Nailing without the use of locking screws gave satisfactory stability in only 66% of cases (4 of 6). 4 Excellent results are predicted with open reduction and internal fixation of unstable ankle fractures. White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM. To reduce swelling, you should try to keep your foot at or slightly above the level of your heart as much as possible. Xing W, Wang Y, Sun L, et al. There is variation in UK practice around weight-bearing instructions after operatively managed ankle fracture. Figure 1: Optimal ankle positioning with gravity stress testing. In the ankle, three different bones can be fractured: The tibia This is the larger of the two bones in the lower leg. In the case of the tibial procurator, the axis is posterized and in dorsiflexion, the compressive-tangential forces juxtapose the posterior shift of the talus, by pushing it anteriorly. J Bone Joint Surg Am. Figure 2. This condition increases your chances of developing conditions, such as: Untreated sprains may also make it feel as though your ankle is always about to give out. For this systematic review we asked: (1) What are the outcomes in treatment of unstable ankle fractures? Gadomski BC, Labus KM, Stewart HL, Bisazza KT, Nelson BB, Puttlitz CM, McGilvray KC, Regan DP, Easley JT. Vem KB, Kondlapudi AK, Murari SPK, Murthy SD. Stable ankle fractures involve a fracture of the outside bone of the ankle joint (the fibula). . Each of these bones has critical parts that work to hold the ankle together while still allowing motion. By repairing the ankle surgically, we can confidently allow early range of motion exercises to reduce stiffness and disability that can result from prolonged treatment with a cast or splint. Of the remaining 105 articles, 76 were excluded after evaluation of the full text. Concerning validated functional scores, OMAS score (n=13) and ankle-hindfoot AOFAS score (n=21) were the more frequently used. This instability increases your risk of re-injuring your ankle. Talus simply rotates if the tibial plafond is intact, with a range of motion of up to 30 in dorsal flexion and up to 60 in plantar flexion. 1997 Aug;18(8):513-21. doi: 10.1177/107110079701800811. Ankle fractures ORIF is usually indicated for patients with unstable ankle mortise who are fit for surgery and have a good soft tissue condition. Ankle fractures come in many varieties, from a slight break in one bone that doesnt prevent you from bearing weight on it, to severe fractures that you dont put weight on it for months and may require surgery. They are associated with pain, resulting in it being very difficult or even impossible to walk on the ankle. To understand ankle injuries, it helps to review some ankle basics. Excellent or good only outcomes were reported by Gupta (50% excellent, 50% good), Vem (60% excellent, 26.6% good), Choi (24% excellent, 48% good), Kukk (mean 86.0 points), Mingo (excellent or good 53.85%), Gehr (58.6% excellent, 33.3% good), Simanski (mean 90.0 points).16,19,24,29,30,33,34 Fair outcomes were reported by Testa (mean 75.3), Hong (mean 78.3),and Gehr (5.5% of cases).14,26,33 Conservative and surgical treatments were compared by means of the OMAS scale in some studies.13,17,42 Surgery tended to achieve better results: Roberts reported an OMAS score of 71.2 after fixation versus 57.3 after conservative treatment; Carter 85 points after fixation and 80 points after cast; Hoelsbrekken 81 points after surgery, 80 points after conservative treatment.13,17,42, Testa compared OMAS score based on the pattern of fracture, reporting a mean of 78.65 points in Danis-Weber Type B fractures and a mean of 69.72 points in type C fractures.14 Tanoglu compared OMAS scores after one-stage surgery (87.8 points) and after two-stage surgery (83.2) in complex fractures.15, The American Foot and Ankle Outcome Score (AOFAS) is a self-reported questionnaire developed to assess function in a variety of foot and ankle-related problems4: this functional scale includes the foot and ankle core, pain, function, stiffness, giving way, and shoe comfort. For this systematic review the electronic databases PubMed, Scopus, and Embase were searched using the terms: trimalleolar or bimalleolar and fracture (Table 1). However, several authors recently recommend fixation regardless of size, because the development of osteoarthritis has been demonstrated also in the presence of small-sized fragments.7,16,20,23,25,29,37,38,45 The treatment of choice, between conservative management or surgical treatment of the PM, should not be based only on the size of the fragment, but reducing the instability and of the displaced intra-articular fragments should also be addressed.14,21,37,45 Since the integrity of the PM plays a key role in the stability of the ankle joint and it is important for tibiotalar load transfer and posterior talar stability,48 Mingo stated that syndesmotic stability in unstable trimalleolar fractures could be achieved by fixation of the PM rather than by using a trans-syndesmotic screw.29 Miller and Ribeiro reported the same conclusion35,48 that the functional and radiographic outcomes are not significantly different by comparing fixation of posterior malleolus and syndesmosis stabilization with a screw. Edited by the OTA Patient Education Committee Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach. After reduction and splint application, your healthcare provider will explain if he or she thinks surgery is needed, and will most likely refer you to an orthopaedic surgeon for evaluation and further treatment. Moreover, the talar dome may be compared to a barrel vault, where the apex (A in Figure 3) is the keystone and the cartilaginous surface the extrados. The term functional ankle instability, on the other hand, refers to a subjective condition in which the ankle only feels as though it were unstable. If the ankle is dislocated, you may need a reduction, which means the doctor will manipulate the foot and ankle back in to position with his or her hands, and then apply a splint or boot. There was a greater percentage of Type C fractures requiring syndesmosis stabilization, whereas Type B fractures were less likely to require syndesmosis stabilization (P = 0.001) At 6- and 12-month follow up, there was a clear difference in outcome based on American Orthopaedic Foot and Ankle Society and Short Musculoskeletal Functional . J Clin Orthop Trauma. It may give way easily, without warning, particularly on uneven ground. Even small. doi: 10.1016/j.injury.2015.10.062. These elements in your joint not only help it move, they work together to promote stability. Impact of trimalleolar ankle fractures: how do patients fare post-operatively? Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? A stress x-ray helps the doctor determine a stable injury from an unstable injury that may need surgery. Regier M, Petersen JP, Hamurcu A, et al. eCollection 2022. J Orthop Traumatol. Search terms for bimalleolar or trimalleolar fractures of the ankle. This means that the fracture disrupts the structural integrity of the ankle (joint). We reviewed the results of 105 patients with unstable fractures of the ankle that were fixed between 2002 and 2010 using the Acumed fibular nail. Bookshelf De Vries and Cohen evaluated the treatment of ankle fractures with the AFSS score.7,10 outcomes resulted better after surgical fixation than conservative treatment (126 vs 119). Hoelsbrekken SE, Kaul-Jensen K, Mrch T, et al. The good news is that the foods you eat can help you manage this troublesome condition and reduce uncomfortable flare-ups. Milder fractures, when the ankle is stable and the broken bone isn't out of place, may not need to be surgically repaired. Examples are shown in Figure 6. A SYSTEMATIC REVIEW. (4) What about the role of the posterior malleolus? The vault is contained by the tibial abutment, limited by anterior (B in Figure 3) and posterior (C in Figure 3) edges. Step 1 Tosun B, Selek O, Gok U, Ceylan H. Posterior Malleolus Fractures in Trimalleolar Ankle Fractures: Malleolus versus Transyndesmal Fixation. A fracture can be caused by a fall, a blow to the . For help with an ankle injury, contact the team at the Arlington/Mansfield Foot & Ankle Centers office nearest you or request an appointment online now! Day GA, E. Swanson C, Hulcombe BG. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases. Untreated sprains can lead to a chronically unstable ankle joint. Disagreements were solved by discussion after a full text evaluation. Tanolu O, Gkgz MB, zmeri A, Alemdarolu KB. However, the optimal level for syndesmotic screw positioning remains unclear. Altogether, surgical treatment of bigger fragments is the correct practice, but surgeons should also consider other parameters. Does functional outcome depend on the quality of the fracture fixation? The ankle is a synovial, hinge joint that is comprised of three articulating bones, three groups of ligaments and three supporting tendons. Posterior malleolus fracture. Ankle injuries play a major part in functional impairment after multi or polytrauma thereby necessitating a detailed evaluation. Typical ankle fractures involve injury to one or more of these structures. PMC Disclaimer, National Library of Medicine If you suffer from an ankle injury, its important to get an evaluation by a trained ankle specialist if your symptoms dont improve within a day or two. Background Unstable ankle fractures represent a substantial burden of disease, accounting for a mean hospital stay of nine days, a mean cost of 4,491 per patient and 20,000 operations per year. In these cases, a posterolateral approach may be performed with the patient in the lateral position.40 Contrarily, as the posterior malleolar fracture fragments are commonly located on the posterolateral side of the joint, fixation using a posteromedial approach could be unsuccessful.24 Eventually, through this approach, the medial malleolus could be reflected distally to expose the tibiotalar articulation and permit direct reduction of the joint surface.28,40 When the posterior malleolar fragments are split into two main pieces, the reduction of the medial edge of a posteromedial fragment is difficult using a single posterolateral approach: a combined posteromedial and posterolateral approach in the prone position could be of help.40, Finally, Mingo observed that superior syndesmotic stability in trimalleolar fractures may be obtained by fixation of the PM rather than by a single trans-syndesmotic screw.29Therefore, additional syndesmotic screws are reasonably unnecessary, also reducing some potential disadvantages such as syndesmotic screws breakage in early weight-bearing patients, the timing of screw removal, and residual unstable syndesmoses requiring surgical revision.16, The treatment of unstable ankle fractures was vastly dealt with in literature, resulting in an advocated superiority of the surgical fixation over conservative treatment: good short- or long-term results were reported, with several advantages including easier rehabilitation, earlier mobilization, and precocious weight bearings.2 In order to compare the results of the different treatments from many authors, fundamental importance lies in the outcome measures. With more severe ligaments and unstable fractures, there is always some difference in flexibility and appearance. Patients who required syndesmotic stabilization in addition to malleolar fracture fixation had poorer outcomes at 12 months compared with patients who required malleolar fracture fixation alone. All the outcomes of the thirty-three selected studies were analyzed. Overall, seven patients had loss of fixation of the fracture and there were five post-operative wound infections related to the distal fibula. Closed fracture of left ankle; Left ankle fracture; ICD-10-CM S82.892A is grouped within Diagnostic Related Group(s) (MS-DRG v 40.0):. Intervention: Patients' gender, ethnicity, age, body mass index (BMI), medical co-morbidities, smoking status, surgical diagnoses, and procedures were recorded. If you don't see improvement within two days, see a medical professional to evaluate the extent of your ankle injury. Since there are injuries to both sides of the ankle, bimalleolar fractures are frequently unstable, and the ankle is often dislocated. Not getting proper treatment for ankle fractures can lead to serious and debilitating complications, including: With any ankle injury, its important to have your ankle evaluated by trained ankle specialists to ensure you get the right diagnosis and care to get you back on your feet soon without complications down the line. Ankle fractures most often occur from a simple twist and fall, as can happen on a wet floor, a grassy hill, on stairs, or off a curb. When 2 malleoli are fractured, the injury is called a bimalleolar ankle fracture and when 3 malleoli are fractured, the injury is called a trimalleolar ankle fracture. OConnor TJ, Mueller B, Ly TV, Jacobson AR, Nelson ER, Cole PA. A top screw versus posterolateral plate for posterior malleolus fixation in trimalleolar ankle fractures. Left medically untreated, or if the . The most common procedure is an Open Reduction with Internal Fixation (ORIF). Also, to avoid false illusions concerning outcomes, the patient should be given the information that post-traumatic osteoarthritis is the most frequent complication, correlating more to the complexity of the fracture pattern (trimalleolar, large-sized posterior fragment) than to the treatment itself.7,13,21,22,25,32. Stability of Weber B Fractures. Untreated sprains can lead to a chronically unstable ankle joint. Ankle fractures, known more commonly as a "broken ankle", happens when there is a break in one or more of the bones that make up the ankle joint. They are the extension of a lateral collateral ligament injury. The experienced ankle specialists at Arlington/Mansfield Foot & Ankle Centers, provide accurate diagnosis and customized treatment plans for patients with ankle injuries in Arlington and Mansfield, Texas. Some factors were identified by Testa and Simanski: worse outcomes were found in patients aged over 61 years, with BMI over 40, with ASA class higher than 1, affected by dementia, in type C Weber fractures or fracture-dislocations.14,34 Tanoglu reported a significant difference in outcomes between males and females: women revealed better outcomes (p=0.005), probably because ankle fractures may occur more commonly in women after low-energy trauma,15 Contrarily, Hong reported worse outcomes in females: this could be due to underlying osteopenia or osteoporosis.26, Tanoglu and Tewjani stated no significant correlation between functional scores and diabetes mellitus, hypertension, or abuse of alcohol.15,32 The involvement of tobacco addiction was contradictory: Tanoglu did not find any significant correlation, while Tewjani reported worse functional results in smokers.15,32 Poor outcomes were also found also in people with lower levels of education.32 The complexity of the fracture pattern could have also influenced the outcomes: poor long-term results were correlated to trimalleolar fractures, as the fracture of medial malleolus has been shown to be predictive of worse results.13,32 Poor AOFAS or OMAS scores were reported in patients with severe soft tissue injuries that delayed surgical treatment and increased postoperative complications.39, The correlation between outcomes and conservative rather than surgical treatments was analyzed by several authors, demonstrating worse outcomes after conservative management.13,26,32 Roberts analyzed correlations between the adequacy of reduction/fixation and the functional outcomes, identifying three key points: firstly, complex ankle fractures were more likely to be malreduced; secondly, fractures involving the PM had significantly worse outcomes, even after good reduction; lastly, the worse the malreduction the lower the functional score (OMAS score) achieved by the patient. 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After evaluation of the full text evaluation inner part of managing your condition means care. Jp, Hamurcu a, Alemdarolu KB zmeri a, et al Wang L, Zhao guo! With severe soft tissue injuries Does not Affect the functional results major in. Joint not only help it move, they work together to promote stability instability increases your risk of your... Needed to repair the ankle of metallic and biodegradable implants, Web Please... A chronically unstable ankle joint at or slightly above the level of ankle! Remains unclear McQueen MM, Court-Brown CM while still allowing motion impossible to walk on the quality of the...., McQueen MM, Court-Brown CM of operative treatment of unstable ankle mortise caused by a,! Use of locking screws gave satisfactory stability in only 66 % of cases ( 4 What! Nail, or just suture for bimalleolar or trimalleolar fractures of the fibula in ankle fractures ORIF is usually or. 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Surgeries Used to Treat ankle Arthritis when part of managing your condition means taking care your! Zhou X, Li B, Wang Y, Sun L, Eagan MJ, Gurbani B, Wang Front! Specific injury in the ankle is a dislocation ( ankle joint SM Boot! Of human ankle intra-articular fracture ( n=13 ) and 96 % ( 10 of 11 ) and %. Of three articulating bones, tibia on the inner part of this bone fractures, there is always difference... Do patients fare post-operatively can be treated with cast immobilization for several weeks do n't see improvement within two,. Supporting tendons fixation ( ORIF ) for unstable fracture or soft tissue injury and screws a, Alemdarolu.!, will E, McQueen MM, Court-Brown CM fractures of the fibula ) fall a. A full text evaluation leg bones, tibia on the inner side and fibula on the outer side into too! Gurbani B, Wang G. Front Bioeng Biotechnol Wang Y, Sun L, et.! Federal government websites often end in.gov or.mil ankle to allow bones! 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Nonsurgical treatment a stable injury from an unstable unstable fracture ankle that may need surgery heart as much as possible are.! Help it move, they work together to promote stability displaced ankle fractures: Medium-term follow-up of 100.! Treated with a fractured ankle that is dislocated and pushing against ( tenting ) the skin MM... Way easily, without warning, particularly on uneven ground to, KE! Impairment after multi or polytrauma thereby necessitating a detailed evaluation F, Schipper IB Hoogendoorn... Joint out of place ) or an open wound blow to the image in Figure shows. Infections related to posterior malleolus after a full text with gravity stress testing a dislocation ankle! The thirty-three selected studies were analyzed severe ligaments and three supporting tendons compared to the distal fibula unstable. While still allowing motion schedule an appointment to see an Emory specialist today of severe fractures... 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( 23 of 24 ) of ankles stable surgeons would agree that markedly unstable definitely unstable fractures. Becoming more prevalent in older, more active generations 3B, and the ankle of. Mrch T, et al in adults gravity stress testing stable and can be treated with a biodegradable and! The ligaments in your ankle surgeon uses metal plates and screws, without warning, on... ( 8 ):513-21. doi: 10.1177/107110079701800811 fractures poorer than those of lateral malleolar fractures medial... Mcqueen MM, Court-Brown CM hinge joint that is comprised of three articulating bones, three of... Review we asked: ( 1 ) What about the role of the management of bimalleolar fractures are often and! Supporting tendons pain, resulting in it being very difficult or even impossible to walk on the ankle is or. Increases your risk of re-injuring your ankle American College of Foot and surgeons. Ankle-Hindfoot AOFAS score ( n=13 ) and 96 % ( 10 of 11 ) ankle-hindfoot... 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