![]() ![]() The direction of rotation, the orientation of the foot while planted and the amount of energy that produces the fracture will determine which bones and ligaments may be injured. Patients with ankle fractures usually present with pain, swelling, and bruising. Patients typically describe an acute twisting injury in which the foot is planted on the ground and the body rotates around it. Although the deltoid ligament cannot be "seen" on the x-ray, the injury is easily inferred, given the widening of the mortise nearby (white arrow). This force also applies traction to the deltoid ligament on the medial side. This type of injury allows the talus to remain anatomically positioned within the mortise, preventing displacement of the joint. Ankle fractures are classified as stable if the fracture is non-displaced or minimally displaced and the medial structures (deltoid ligament and medial malleolus) are intact. Regarding the soft tissues, the single most important feature to note is whether the fracture is "open," that is, that the skin is broken.Īnother important consideration is the stability of the ankle joint (Figure 3). It may be best, therefore to describe ankle fractures by the bones involved (i.e., isolated medial/lateral malleolar, bimalleolar, trimalleolar, etc.) and the presence of absence of soft tissue injury. There are many methods of classifying ankle fractures: some are too simple (and therefore not very informative), and others provide more detailed information (yet become unwieldy and unreliable). The surface may crack and not bend in response to a new load. The loss of compliance makes the entire system more prone to damage. This new bone in turn makes the tissue below the cartilage more rigid (technically speaking less compliant). This is in accordance with Wolff's Law, which states that bone grows in response to load. ![]() Thus, a smaller area of contact for a given load leads to higher pressure. Recall that pressure is defined by the force (load) divided by area. This abnormal motion leads to focal pressure points which can be damaging. When the mortise is disrupted by a fracture, the talus is free to move more than it should.
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