Abnormal forces that rotate the talus within the mortise push the tibia and fibula apart and may cause an injury to the syndesmotic ligaments or a fracture. These structures prevent the distal tibia and fibula from separating. Support is provided by the anterior tibiofibular ligament, the posterior tibiofibular ligament, the transverse tibiofibular ligament (posteriorly), and the interosseous membrane, which extends from the ankle proximally. The syndesmosis of the ankle refers to the articulation of the distal tibia and fibula ( figure 7). The peroneal tendons, anterior and posterior tibialis tendons, Achilles tendon, and joint capsule provide additional support ( figure 6). The medial ankle complex consists of the deep and superficial fibers of the deltoid ligament ( figure 5). The lateral ligament complex consists of the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament ( figure 4). The mortise gains its stability from the bony relationships of the ankle and from surrounding structures. The weight-bearing portion of the mortise consists of the tibial plafond and the talar dome. These bones are held together by the ligaments of the ankle to form a mortise. ĬLINICAL ANATOMY - The bony anatomy of the ankle consists of the articulation of the distal tibia and fibula with the talus ( figure 1 and figure 2 and figure 3). In contrast to fractures of the radius and other fractures common among perimenopausal and postmenopausal women, bone density has not been clearly demonstrated to be a major risk factor. Ĭigarette smoking and a high body mass index have been associated with ankle fractures. There are similar fracture rates overall between women and men, but men have a higher rate as young adults, while women have higher rates in the 50- to 70-year age group. The vast majority of ankle fractures are malleolar fractures: 60 to 70 percent occur as unimalleolar fractures, 15 to 20 percent as bimalleolar fractures, and 7 to 12 percent as trimalleolar fractures. Since the mid-1900s, this rate has increased significantly in many industrialized countries, most likely due to growth in the number of people involved in athletics and in the size of the elderly population. (See "Fibula fractures" and "Overview of tibial fractures in adults" and "Ankle sprain in adults: Evaluation and diagnosis" and "Non-Achilles ankle tendinopathy".)ĮPIDEMIOLOGY AND RISK FACTORS - The incidence of ankle fractures is approximately 187 fractures per 100,000 people each year. Fibular fractures above the lateral malleolus, tibial fractures, and ankle injuries other than fractures are discussed elsewhere. This topic review will provide an overview of ankle fractures that result from minor trauma (ie, indirect or low energy fractures), including a basic approach to their evaluation and management. Over five million ankle injuries occur each year in the United States alone. INTRODUCTION - Ankle fractures are increasingly common injuries that necessitate a careful approach for proper management.
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