Ankle pathology

Question 1

What is the name of the rule to follow prior to ordering an ankle XR?

What are the criteria of this rule?

Answer 1

Ottawa rules for ankle fracture

Pain in the malleolar region with any one of the following:

• Bony tenderness over the lateral malleolus (distal fib)
• Bony tenderness over the medial malleolus (distal tib)
• Inability to weight bear on four steps at the time of injury and in the emergency department.

Question 2

What classification is commonly used for ankle fracture?

Answer 2

Most commonly Webers classification. Split into A, B and C.

Question 3

Describe the common ankle fracture classifications

Answer 3

Weber A: below the level of the syndesmosis

Weber B: through the syndesmosis

Weber C: above the syndemosis

Question 4

What is the management for ankle fractures?

Answer 4

Conservative management often in the elderly: e.g. walking cast boot

In younger individuals usually managed with surgery - e.g. ORIF (compression plate)

Question 5

What is a key sign of an unstable ankle fracture?

Answer 5

The syndesmosis is affected

Talar shift (>5mm)