Ankle Fractures: NEET PG Essentials
1. Danis-Weber Classification
This system classifies ankle fractures based on the level of the fibula fracture relative to the syndesmosis:
- Type A: Below the level of the syndesmosis. Usually stable.
- Type B: At the level of the syndesmosis. Variable stability.
- Type C: Above the level of the syndesmosis. Unstable, involves syndesmotic injury.
2. High-Yield Clinical Associations
| Term/Condition | High-Yield Detail |
|---|---|
| Lauge-Hansen | Classification based on foot position and direction of force (e.g., Supination-External Rotation). |
| Trimalleolar | Fracture of the lateral, medial, and posterior (Volkmann’s triangle) malleoli. |
| Ottawa Rules | Criteria to determine the necessity of ankle X-rays: helps reduce unnecessary imaging. |
3. Examination & Management Pearls
- Syndesmotic Injury: Always check for tenderness over the distal tibiofibular ligament. Perform the Squeeze test or External rotation stress test to assess stability.
- Medial Malleolar Tenderness: High-energy ankle fractures often present with deltoid ligament injury; if the medial side is tender, assume an unstable pattern until proven otherwise.
- Posterior Malleolus: If >25-30% of the articular surface is involved, open reduction and internal fixation (ORIF) is typically indicated to maintain talar stability.
- Talar Shift: Widening of the medial clear space on X-ray is a sign of deltoid ligament disruption and potential instability.
- Post-op Management: Early range of motion is key to preventing post-traumatic stiffness, provided the fixation is rigid.