Malleolar ankle fractures. A guide to evaluation and treatment

Malleolar ankle fractures are commonly encountered in orthopaedic trauma practice. The goal for treatment of these injuries is to maximize function and minimize complications. The treatment programme is based on the nature of osseoligamentous and soft tissue injury, the functional requirements of the patient and the overall medical condition of the patient. Non-operative treatment is usually reserved for stable fractures of the lateral malleolus; unstable bimalleolar and trimalleolar injuries are usually treated operatively. Staged treatment with initial external fixation and delayed definitive internal fixation is utilized to avoid soft tissue complications in high energy injuries. The Danis–Weber and Lauge-Hansen classification systems are useful for systematic diagnosis and formulation of a treatment plan of specific fracture patterns and ligamentous injuries. Definitive operative treatment is focused on the restoration of the anatomy of the ankle mortise. Injury to the medial malleolus and medial ligaments, the fibula, the syndesmosis and the posterior malleolus are addressed sequentially. The postoperative rehabilitation programme is designed based on the severity of the injury and the patient profile.