Case history

Case history

A 52-year-old woman presents after severely twisting her right ankle coming down her steps with immediate pain over her lateral malleolus. On examination her right ankle is acutely swollen and tender over the lateral malleolus, and the foot is externally rotated and laterally positioned. She is unable to weight-bear.

Other presentations

Ankle fractures are usually the result of a low-energy fall but may also be seen in those who have had high-energy trauma.[4][5][6][7]​​​​​ At the higher energy extreme there may be damage to the overlying skin, resulting in an open fracture, and the wound being commonly on the medial aspect of the ankle.[8][9]​​ More infrequently, there may be concomitant damage to the vascular supply of the foot from dislocation and subsequent kinking of vessels due to the non-anatomical placement of the foot or to direct damage of the vessels themselves.

Another presentation of disruption of the ankle joint is eponymously known as Maisonneuve's fracture.[1]​[10] This presents with pain and swelling proximally in the fibula and associated pain in the leg and ankle.[1]​ This results from the presence of a high fracture of the fibula with a concomitant separation of the tibiofibular syndesmosis and fracture of the medial malleolus or rupture of the medial ankle ligament complex, essentially representing a dissociation of the tibia and fibula below the level of the fibula fracture.[1]​

The presentation of ankle fractures may be delayed due to conditions that have associated peripheral neuropathy, such as diabetes mellitus.

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