Bimalleolar fracture
Frequent trauma cases
Skin condition is critical.
Can be dislocated (urgent reduction is mandatory)
for lateral malleolus fracture, Syndemosis injury may be present according to the Weber classification
Treatment : short-leg walking cast/boot
isolated nondisplaced medial malleolus fracture or tip avulsions
isolated lateral malleolus fracture with < 3mm displacement and no talar shift
bimalleolar fracture if elderly or unable to undergo surgical intervention
posterior malleolar fracture with < 25% joint involvement or < 2mm step-off
Surgical treatment: all other cases.
Melleolus fracture: lateral, medial and posterior
Weber classification
Other fractures
Pilon fracture (tibial plafond)
Fracture of the distal tibia, with articular extension.
Can be communitive
Higher risk to develop osteoarthritis.
The majority needs osteosynthesis.
Talus fracture
high risk of avascular necrosis
non displaced fracture can be treated with casting
displaced fractures must be reduced and fixed with screws
Calcaneus Fracture
can be bilateral, and associated with spine fractures
non displaced fracture can be treated with posterieur splint. displaced articular fractures should be operated, to avoid osteoarthritis.
complexe pilon fracture
For all ankle fractures, weight bearing is forbidden. Skin condition should be watched.
RICE protocol (Rest, elevation, compression and elevation) is essential.
Preventive anticoagulation is needed