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J Am Acad Orthop Surg, Vol 11, No 6, November/December 2003, 403-412.
© 2003 the American Academy of Orthopaedic Surgeons
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Ankle Fractures Resulting From Rotational Injuries

James D. Michelson, MD

Dr. Michelson is Professor, Orthopaedic Surgery, and Director, Clinical Informatics, George Washington University Hospital, George Washington University Hospital Medical Center Medical Education and Simulation Center, Washington, DC.

Reprint requests: Dr. Michelson, GWUMC Medical Education and Simulation Center, Room 6200, 900 23rd Street NW, Washington, DC 20037.

Ankle fractures are among the most common skeletal injuries; selection of an optimal management method depends on ankle stability. Stable fractures (eg, isolated lateral malleolar) generally are managed nonsurgically; unstable fractures (eg, bimalleolar, bimalleolar equivalent) usually are managed with open reduction and internal fixation. Stress radiographs may aid in the management of incomplete deltoid injury in which there is medial swelling and tenderness without radiographic talar shift. A posterior malleolar fracture should be reduced and stabilized if it comprises >30% of the articular surface and remains displaced after fibular stabilization. Ankle fractures with syndesmotic injury have additional tibiofibular instability that can be controlled by screw fixation. However, the choice between metal and bioabsorbable screws, screw size, number of cortices fixed, and indications for screw removal remain controversial. Conditions such as diabetes or advanced age are no longer contraindications to usual management recommendations.






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Copyright © 2003 by the American Academy of Orthopaedic Surgeons.