Ankle fractures - overview and emergency assessment
Ankle fractures are a common emergency presentation, ranging from stable isolated malleolar breaks managed conservatively to complex intra‑articular or open injuries requiring urgent specialist care. The emergency clinician must rapidly assess mechanism, soft‑tissue condition and neurovascular status, apply validated imaging rules, classify the injury in terms of likely stability, start acute management, and identify red flags that mandate urgent orthopaedic input or transfer.
Key ED priorities
- Apply the Ottawa ankle and foot rules to determine whether radiography is required (NICE NG38).
- Obtain an appropriate ankle (and/or foot) radiographic series when indicated and aim for a definitive radiology report before discharge when possible (hot reporting) (NICE NG38).
- Perform a structured neurovascular and soft‑tissue assessment and document findings before and after any reduction.
- Immobilise and provide analgesia promptly. Give IV antibiotics early for open fractures and arrange urgent orthopaedic/trauma referral (NICE NG37).
- Provide weight‑bearing advice based on fracture stability: stable unimalleolar fractures may tolerate immediate weight‑bearing as advised in NG38; unstable or complex injuries require non‑weight‑bearing and orthopaedic review.
Anatomy relevant to assessment
- The ankle (tibiotalar joint) comprises the distal tibia (medial and posterior malleoli), distal fibula (lateral malleolus) and talus; the tibia and fibula form the mortise that constrains the talus.
- The distal tibiofibular syndesmosis (anterior and posterior inferior tibiofibular ligaments and the interosseous...