Ankle stability in ankle fracture

Abstract

Restoration of normal ankle kinematics should be the all-encompassing ethos in the approach to management of ankle fractures. To do this, the ligamentous stabilisers must also form part of its assessment and definitive management and be considered during index fracture fixation surgery. This article is a review of the anatomy, mechanics and clinical testing of instability in ankle fractures.

Keywords: Ankle fracture; Ankle instability; Fibular; Ligaments; Malleolar.

Fig. 1

3D image of ankle skeleton with a movement sphere overlay showing the possible translation in the sagittal and frontal planes and rotation in the sagittal, frontal and horizontal planes.

Fig. 2

3D image of ankle skeleton showing sagittal plane translation and rotation.

Fig. 3

D image of ankle skeleton showing frontal plane translation and rotation.

Fig. 4

3D image of ankle skeleton showing horizontal plane rotation.

Fig. 5

3D image of ankle skeleton with schematic representation of the supporting ligaments (ATFL – anterior talofibular ligament, PTFL – posterior talofibular ligament, AITFL – anterior inferior tibiofibular ligament, PITFL – posterior inferior tibiofibular ligament, CFL – calcaneofibular ligament).

Fig. 6

Anteroposterior radiograph of left ankle showing medical clear space greater than 5 mm with displaced fibular fracture.

Fig. 7

Intraoperative loss of tibiofibular overlap as a result of an internal rotation test on a type 1 Mason and Molloy posterior Malleolar fracture following fibular fixation (first image). This overlap is corrected on syndesmotic fixation and retesting showed normal tibiofibular overlap on repeat screening (second image).