Materiały źródłowe

• #1 Ankle Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542324/

  Ankle fractures are common injuries that could result from a range of mechanisms, such as a trivial twisting in frail adults up to high-energy trauma in the young population. Treatment of ankle fractures aims to restore joint alignment and stability to reduce the risk of post-traumatic ankle arthritis. […] Ankle fractures can be caused by various types of trauma, such as twisting, impact, and crush injuries. Falling, tripping, or sports activities may lead to twisting forces through the ankle. Impact injuries can occur from a fall from height, resulting in impaction of the distal tibia and fibula against the talus. An ankle crush injury may result from a road traffic accident or the ankle being trapped under a heavy object. The degree of bony comminution and soft tissue damage is directly related to the energy of the trauma.

• #1 The Radiology Assistant : Ankle Fracture Mechanism and Radiography

  https://radiologyassistant.nl/musculoskeletal/ankle/fracture-mechanism-and-radiography

  The ankle is the most frequently injured joint. […] The ankle joint has to be flexible in order to deal with the enormous forces applied exerted on the talus within the ankle fork. […] There are two positions of the foot in which the flexible ankle joint becomes a rigid and vulnerable system: extreme supination and pronation. […] In 80% of ankle fractures the foot is in supination. […] In 20% of fractures the foot is in pronation with maximum tension on the medial side. […] The shape of a fracture indicates which forces were involved. […] The ankle can be thought of as a ring in which bones as well as ligaments play an equally important role in the maintenance of joint stability. […] When it is broken in two places, the ring is unstable and may dislocate. […] It becomes more problematic when there is a combination of a fracture and a ligamentous rupture, because the ligamentous rupture is not detectable on the X-ray.

• #1 Adult Ankle Fractures (Ankle and Foot Soft Tissue Injuries and Fractures) | PM&R KnowledgeNow

  https://now.aapmr.org/adult-ankle-fractures-ankle-and-foot-soft-tissue-injuries-and-fractures/

  Ankle fractures typically result from a sudden, forceful twisting movement in multiple planes. Such movements almost always include inversion or eversion. However, the exact combination of forces that produce a particular pattern of fracture is still not clear. The Lauge-Hansen classification system for ankle fractures attempts to link mechanism of injury and fracture pattern. However, one report found that nearly 53% of the ankle injuries did not coincide with the predicted injury pattern based on mechanism of injury, and that 14% had a common fracture pattern not explained by the various combination of forces proposed by Lauge-Hansen. Similarly, a recent small study found that the mechanisms proposed by Lauge-Hansen were only 58% accurate in predicting actual fracture patterns. […] The ankle joint is a hinge synovial joint made up of the trimalleolar complex comprised of the medial, lateral, and posterior malleoli. Stability is achieved due to the bony articulation with the talus and a complex network of ligaments, syndesmosis and muscles. Depending on the position of the foot and the direction of the twisting force, one or more of these ligaments and malleoli can be injured. The lateral malleolus is implicated with an inversion position and an adduction force, which stresses the lateral ligaments. If forceful enough, this may avulse the lateral malleolus. If the twisting force continues, the talus may shift and impact the medial malleolus, causing an oblique fracture. The medial malleolus is implicated in an eversion position and an abduction force, stressing the deltoid ligament complex and potentially leading to a medial malleolus avulsion fracture. Again, if the force continues, the talus will shift laterally and impact the lateral malleolus, causing an oblique fracture. The addition of an axial compression force to the everted ankle can injure the posterior malleolus. If external rotation of the talus is added, syndesmotic injury and proximal fibula fractures (e.g., Maisonneuve fractures) may occur. According to original research, the most common mechanisms included supination-external rotation fractures accounting for 40-75% of ankle fractures; supination-adduction for 10-20%; pronation-abduction for 5-21% and pronation-external rotation for 7-19%.

• #1 Ankle Fracture Management in the ED: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/824224-overview

  The primary motion of the ankle at the true ankle joint (tibiotalar joint) consists of plantarflexion and dorsiflexion. Inversion and eversion occur at the subtalar joint. […] Excessive inversion stress is the most common cause of ankle injury for 2 anatomic reasons. First, the medial malleolus is shorter than the lateral malleolus, allowing the talus to invert more than evert. Second, the deltoid ligament stabilizing the medial aspect of the ankle joint offers stronger support than is offered by the thinner lateral ligaments. As a result, the ankle is more stable and is more resistant to eversion injury than inversion injury. However, when eversion injury occurs, bony and ligamentous supporting structures undergo substantial damage, and loss of joint stability is noted. […] Posterior malleolar fractures are usually associated with other fractures and/or with ligamentous disruption. They are commonly associated with fibular fractures and are often unstable. […] Transverse malleolar fractures usually represent an avulsion-type injury. Vertical malleolar fractures result from talar impaction.

• #1 Ankle Fractures (Broken Ankle) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/ankle-fractures-broken-ankle/

  A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. […] Doctors classify ankle fractures according to the area of the bone that is broken. For example, a fracture at the end of the fibula is called a lateral malleolus fracture, or if both the tibia and fibular are broken, it is called a bimalleolar fracture. […] Ankle fractures can be classified by how much the pieces of bone have moved out of their normal position. […] Many types of injuries can cause an ankle fracture. They include: Twisting, rotating, or rolling your ankle while walking or running; Tripping or falling from a height, such as a fall from a ladder; Impact during a car accident. […] A syndesmosis injury can also involve both a ligament sprain and one or more fractures. In these cases, surgery is required. In addition to repairing the fracture(s), the syndesmosis is repaired with one or more screws that can later be removed.

• #1 Ankle Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542324/

  The ankle joint’s bony and ligamentous structures form a complete ring. When the ring is broken, it happens in 2 places. A full assessment of the ankle ring is necessary to avoid missing any bony or ligamentous injuries. Several systems have been developed to classify ankle fractures. […] Anatomical classification categorizes ankle fractures depending on the anatomical location into the following: Isolated medial malleolus fracture, Isolated lateral malleolus fracture, Bimalleolar ankle fracture, Trimalleolar ankle fracture. […] Danis-Weber classification categorizes ankle fractures based on the localization of the distal fibula fracture line relative to the syndesmosis into 3 types: Weber type A, Weber type B, Weber type C. […] The Lauge-Hansen Classification is based on the foot’s position and the direction of the force that causes the injury. This classification categorizes ankle fractures into 4 types.

• #1

  https://link.springer.com/article/10.1007/BF02749126

  Injuries to the ankle joint are common. Complete ligament ruptures and fractures of the malleoli and adjacent bones can affect the stability of the ankle joint. If fractures or ligament injuries are present on both sides of the joint, the ankle will usually be unstable. On the other hand, injuries confined to one side of the joint will usually be stable. Unstable ankle joints require operative fixation, whereas stable ankles do well with conservative treatment. Specific ligament injuries precede several fractures. Recognition of the various patterns of injury permits reliable prediction of these ligament injuries. Therefore, it is important for radiologists and others who interpret trauma radiographs to understand the common mechanisms of injury and to recognize these patterns. […] Correct classification of the injury mechanism should lead to prompt, appropriate diagnosis and treatment and should decrease long-term morbidity.

• #1 Fractures of the Ankle: Pathogenesis and Treatment

  https://www.medscape.com/viewarticle/410433

  The management of ankle fractures is based on an understanding of their pathogenesis. […] Thus, from the radiographic appearance, one may determine the mechanism of injury, and from the end result, the adequacy of treatment.

• #1 Ankle Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542324/

  Maisonneuve injury is an unstable ankle injury caused by pronation and external rotation injury. Maisonneuve injury combines a proximal fibular fracture with tibiofibular syndesmosis and deltoid ligament injury with or without medial malleolus fracture. This unstable injury requires operative treatment. […] Pilon fracture is the comminuted fracture of the tibial plafond, which is the distal end of the tibia, including the articular surface. Pilon fracture usually results from high-energy axial loading trauma, eg, a fall from a height that causes impaction of the talus against the tibial plafond. […] Bosworth fracture-dislocation is a rare type of ankle fracture dislocation where the fibula is dislocated posteriorly. The posterior tibial border blocks the fibula from reduction; therefore, operative treatment is required to reduce and fix the fibula in the incisura fibularis (fibular notch).

• #1 Maisonneuve fracture – Wikipedia

  https://en.wikipedia.org/wiki/Maisonneuve_fracture

  The Maisonneuve fracture is typically a result of excessive, external rotative force being applied to the deltoid and syndesmotic ligaments. […] Forceful, external rotation of the ankle joint results in the tearing of the deep deltoid ligament and/or an avulsion fracture of the medial malleolus. […] The ankle mortise is subjected to excessive torque, rupturing the syndesmotic ligaments and anteromedial ankle joint capsule. […] Rotative energy is transferred upwards along the interosseous membrane, damaging it in the process. […] The force results in a spiral, sometimes an oblique, fracture at the neck of the proximal fibula. […] Although most Maisonneuve cases report a pronation-external rotation mechanism of injury, clinical studies have recorded instances of supination-external rotation being the mechanism of injury. […] A long-term effect of this is painful ankle osteoarthritis due to the direct contact between the tibia and talus. […] If a Maisonneuve fracture is left untreated, instability of the tibiotalar joint and deltoid ligament can cause a valgus deformity of the ankle.

• #1 Bosworth ankle fracture-dislocation: current concept review in: EFORT Open Reviews Volume 9 Issue 6 (2024)

  https://eor.bioscientifica.com/view/journals/eor/9/6/EOR-23-0050.xml

  The BF is a complex injury affecting multiple structures of the ankle joint, with the specific common feature being the displacement of the fractured fibula from the FN behind the posterior aspect of the distal tibia. […] A classic BF is associated with a Weber type B fracture of the distal fibula, with displacement of the proximal fibular fragment from the FN behind the posterior aspect of the distal tibia. This pattern dominates in the literature, occurring in 168 (94%) cases. […] Injury to the anterior tibiofibular ligament (ATFL) is a typical component of BF. […] An osteochondral fracture of the talus associated with BF was reported by Lui et al., Schepers et al., and Saraiva et al. […] Clinical examination in BF is the same as in other ankle fractures and fracture-dislocations.

• #1 The Radiology Assistant : Algoritm for Ankle Fractures 2.0

  https://radiologyassistant.nl/musculoskeletal/ankle/fractures-video-lesson-1

  The mechanism of a Weber C is a result of a position of the foot in pronation with an exorotation force applied by the foot and that is why Lauge-Hansen calls it pronation exorotation (PER). […] The stages are: […] Due to the pronation there is enormous stress on the medial collateral bands and thats where the injury will start with either a band rupture or an avulsion of the medial malleolus (stage 1). […] As the exorotation force continues the anterior syndesmosis will rupture (stage 2). […] As a result of the pronation of the foot, the bands on the lateral side are all without any tension. As the exorotation of the foot continues the distal fibula follows this exorotation movement, while the proximal fibula is held in position at the proximal tibiofibular joint and you get a twist-like fracture somewhere above the level of the syndesmosis (stage 3). […] And finally in stage 4 there will be a rupture of the posterior syndesmosis or tertius avulsion (stage 4).

• #1

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/malleoli/transsyndesmotic-lateral-isolated-simple-fracture/circular-cast

  The typical mechanism of injury in transsyndesmotic fractures is external rotation of the talus in the ankle mortise with the foot in supination (Lauge-Hansen supination external rotation injury), producing first a transsyndesmotic, oblique fibular fracture from distal anterior to proximal posterior. The talus then dislocates posteriorly, sometimes producing a posterior tibial fracture (Volkmanns fragment). Finally, the medial side fails (either a deltoid rupture or a medial malleolar fracture). Less commonly these fractures are cause by an abduction force (Lauge-Hansen abduction injury). The fracture of the lateral malleolus may be transverse or complex with some buckling of the lateral cortex. […] The typical clinical displacement in transsyndesmotic fractures is posterior and lateral, usually with the foot lying externally rotated.

• #1 Mechanism of posterior malleolar fracture of the ankle

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8022911/

  Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury. […] Several mechanisms for posterior malleolar fracture have been proposed: avulsion by the posterior inferior tibiofibular ligament, pressure from the externally rotating talus, pressure from the lateral malleolar fragment, and axial loading from the talus. […] The true mechanism of posterior malleolar fracture has remained unclear. In the study described herein, we were able to confirm that the fractures at the posterolateral corner of the distal tibia (i.e., Type I according to the CT-based Haraguchi fracture classification) were posterior inferior tibiofibular ligament avulsion fractures resulting from external rotation of the talus. Furthermore, we successfully produced a fracture involving the entire posterior tibial margin and consisting of 2 fragments (i.e., Haraguchi Type II); with the fragment of the posterior tubercle judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the fragment of the posteromedial margin of the tibial plafond a consequence of axial loading from the talus. […] Understanding the injury mechanism of posterior malleolar fracture may provide insight into the indications for fixation and the optimal stabilization method.

• #1 Ankle Fracture | Orthopaedic Trauma Association (OTA)

  https://ota.org/for-patients/find-info-body-part/3821

  Ankle fractures are common. They usually happen from a twist and fall, like on wet floors, grassy hills, stairs, or curbs. Since there are many bones and ligaments, one or many of these structures can be hurt. The most common break is in the fibula (smaller leg bone). […] The more serious the injury, the more likely it will need surgery. Ankle fractures can have one, two, or three broken bones. When two bones are broken, it’s called a bimalleolar ankle fracture. When three bones are broken, it’s called a trimalleolar ankle fracture. Stable fractures can sometimes heal with a cast or boot. Unstable fractures may need surgery. Unstable ankle fracture mean the talus bone moves and the tibia and fibula can’t keep it in place. […] Some ankle fractures can be treated with a protective boot and early weight-bearing. More serious injuries may need surgery. Surgery helps the ankle heal and allows for early movement to avoid stiffness. Your doctor will decide the best timing and method for surgery.

• #1 Ankle Fractures

  http://www.orthoteers.com/junior.aspx?section=32

  Ankle fractures usually arise as a result of indirect forces, with the foot either being externally rotated, everted, inverted, or less commonly internally rotated on the tibia. […] The important factor in ankle fractures is the stability of the ankle mortice. If the mortice is stable, that is to say no abnormal movement of the talus is possible, the injury is usually easily managed. […] If however the mortice is disrupted, it must then be reconstructed and held until bone and soft tissue healing is complete.

• #1 Ankle Fracture – FootEducation

  https://footeducation.com/ankle-fracture/

  Ankle fractures can be broadly divided into two groups: […] Understanding the mechanism of injury helps doctors to treat ankle fractures. […] Most ankle fractures occur following an acute twisting injury when the foot is planted on the ground and the body rotates around it. […] If the foot rotates inward, either the ligaments stabilizing the outside of the ankle will tear (sprain) or the medial malleolus will break first, followed by a fracture of the fibula as the rotation continues. […] For successful treatment of an ankle fracture, it is very important for the ankle to be well aligned. […] A stable ankle fracture occurs when the broken bones and ligament damage is mild enough that the ankle does not displace even with weight bearing. […] An unstable ankle fracture occurs when the injury has disrupted the containment of the talus and it shifts, either to the side or to the front or back. […] Unstable ankle fractures typically benefit from surgery to realign the ankle joint and hold it in place while it heals. […] Unfortunately, even with ideal treatment, some patients with unstable ankle fractures may develop ankle arthritis as a result of the severity of the joint damage.

• #1 Protective effect and mechanism of microRNA‑146a on ankle fracture

  https://www.spandidos-publications.com/10.3892/etm.2020.9131

  The present study investigated the expression and role of microRNA146a (miR146a) on ankle fracture, and explored the underlying mechanism. […] The results demonstrated that miR146a was significantly downregulated in the blood of patients with ankle fracture. […] The protein levels of tumor necrosis factor (TNF), interleukin (IL)1 and IL6 were significantly upregulated in patients with ankle fracture. […] In addition, MDA content significantly increased, and SOD and CAT activity significantly decreased in patients with ankle fracture. […] In vitro experiments demonstrated that miR146a overexpression significantly enhanced cell viability. […] miR146a mimic suppressed BKinduced upregulation of TNF, IL1, IL6 and MDA, and increased SOD and CAT activity. […] Finally, miR146a mimic inhibited activation of the TRAF6/NFB pathway whilst miR146a inhibitor had the opposite effect.

• #1 Protective effect and mechanism of microRNA‑146a on ankle fracture

  https://www.spandidos-publications.com/10.3892/etm.2020.9131

  In conclusion, miR146a may be a potential therapeutic target for the treatment of ankle fracture by inhibiting the inflammatory response and attenuating oxidative stress. […] Therefore, the inflammatory response serves an important role in the pathogenesis of ankle fractures whilst oxidative stress has also been implicated in affecting fractures. […] The present study investigated the expression and role of miR-146a in the development of fractures. […] These results indicated that miR-146a was significantly decreased during fracture, further suggesting that it might serve an important role in fracture development. […] To confirm the elevated inflammatory response and oxidative stress during ankle fracture, levels of pro-inflammatory factors, including TNF-, IL-1 and IL-6, and bio-markers of oxidative stress, including MDA, SOD and CAT, were determined. […] The results demonstrated that miR-146a overexpression markedly inhibited the TRAF6/NF-B pathway following BK treatment, whilst miR-146a inhibition promoted the TRAF6/NF-B pathway.

• #1 Ankle Fracture Surgery – Pearland, TX Foot and Ankle Doctor

  https://www.coastalfaa.com/ankle-fractures-treatment-and-surgery/

  Ankle fractures range from relatively minor twisting injuries to those associated with violent disruption of the ankle. There are two different mechanisms of injury that have different effects on the structure of the ankle: […] A twisting mechanism and the body rotates around the foot […] A crushing type mechanism that impacts the foot. The twisting type of injuries are far more common, and although there is less likelihood of damage to the cartilage, the bones that make up the ankle joint must nonetheless be carefully re-aligned. The second type of injury that occurs from a fall from a height, or in a motor vehicle accident, is usually far more serious and often associated with cartilage damage. […] If the shape and anatomy of the ankle are not accurately restored, the cartilage lining of the ankle will be disturbed. This will inevitably lead to arthritis.

• #1 Ankle Fracture Surgery – Pearland, TX Foot and Ankle Doctor

  https://www.coastalfaa.com/ankle-fractures-treatment-and-surgery/

  Therefore, the goal of treating all ankle fractures is to re-position the bones to prevent the occurrence of arthritis. […] If the ankle is not repaired correctly or does not heal well, arthritis and deformity of the ankle can occur. Some of these patients will have no other option but to have the ankle surgery re-done.

• #1 Ankle Fractures – OrthoPaedia

  https://www.orthopaedia.com/ankle-fractures/

  Even with optimal treatment, some ankle fractures may result in post-traumatic ankle arthrosis as damage to the articular surface at the time of injury can lead to chondrocyte death. […] The likelihood of post-traumatic ankle arthritis increases with the severity of the initial ankle fracture. […] Sub-optimal reduction of the joint and resultant abnormal biomechanics will also promote the development of ankle arthrosis.

• #1 Fractured ankle: How to treat them and how to recover from them | The Foot Hub

  https://thefoothub.com.au/fractured-ankle/

  Fractured ankles can be serious injuries and therefore require medical treatment. Failure to treat them properly can result in poor healing and a range of long-term complications including lack of mobility, chronic pain and arthritis. […] Broken ankles can occur if you: trip or falling, twist or rotate you ankle, often putting your foot down awkwardly, experience heavy impact on your ankle, through sport or physical activity, motor vehicle accidents. […] If you fracture your ankle it’s very important that you seek medical treatment. If left untreated, some fractures may not heal properly, or may not heal at all and remain broken. Fractures that don’t heal properly can lead to complications such as ankle instability, chronic pain and arthritis. […] Ankle fractures are classified according to the area of the bone that is fractured. The severity depends on the amount of force that caused the fracture.

• #1 Ankle fracture – Wikipedia

  https://en.wikipedia.org/wiki/Ankle_fracture

  Ankle fractures may result from excessive stress on the joint such as from rolling an ankle or from blunt trauma. […] The stability of the ankle joint often dictates treatment. Certain fracture patterns are stable and are thus treated without surgery similarly to ankle sprains. Unstable fractures require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs. […] Specific complications associated with surgical treatment of ankle fractures include fracture healing in an abnormal position (malunion), post-traumatic arthritis, failed fracture healing after a prolonged period of time (nonunion), and decreased range of motion (post-operative stiffness).

• #1

  https://www.footcaremd.org/conditions-treatments/ankle/high-ankle-sprain

  The goals of treatment are to move the tibia and fibula to the correct positions with respect to each other and to heal in those positions. This allows the ankle joint to function as intended. […] It is important to do early range of motion passively, meaning with the help of a physical therapist who moves the ankle, to help avoid stiffness. […] Outcomes generally are good if the injury is recognized and treated appropriately. It is more likely, however, to have some stiffness of the ankle after a high ankle sprain as compared to a standard ankle sprain. This is especially true if a fracture has occurred. […] Arthritis also can develop from a very severe sprain if the cartilage of the ankle is damaged at the time of the original injury.

• #1 Foot Fractures Frequently Misdiagnosed as Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0901/p785.html

  Most ankle injuries are straightforward ligamentous injuries. However, the clinical presentation of subtle fractures can be similar to that of ankle sprains, and these fractures are frequently missed on initial examination. Fractures of the talar dome may be medial or lateral, and they are usually the result of inversion injuries, although medial injuries may be atraumatic. Lateral talar process fractures are characterized by point tenderness over the lateral process. […] Overall, optimal results are achieved with early diagnosis and treatment of these fractures. When treatment is delayed, patients tend to have a more complex clinical course. […] Fractures of the talar dome are generally the result of inversion injuries of the ankle. They are located medially or laterally with equal frequency and occasionally through both. Lateral talar dome fractures are almost always associated with trauma, while medial talar dome lesions can be traumatic or atraumatic in origin.

• #1 Fractured ankle: How to treat them and how to recover from them | The Foot Hub

  https://thefoothub.com.au/fractured-ankle/

  Fractured ankles often require a multidisciplinary approach. Podiatrists can be part of your care team as we are well-trained in diagnosing and management of broken ankles. Treatment may involve wearing an offloading boots which are designed to keep the bone in place as it heals. […] Ankle fractures are serious and require immediate medical attention. If a broken ankle isn’t treated appropriately, it can lead to further damage of your joint, and severely limit your mobility and ability to be active.

• #1 Salter Harris Type II Physeal Ankle Fracture: A review of 10 cases | The Foot and Ankle Online Journal

  http://faoj.org/2010/07/01/salter-harris-type-ii-physeal-ankle-fracture-a-review-of-10-cases/

  The most important determinant of PPC is the fracture displacement following reduction. […] Knowledge of common pediatric ankle fracture patterns and the pitfalls associated with their evaluation and treatment will aid the clinician in the effective management of these injuries. PPC is a common problem following Salter and Harris type II fractures of the distal tibia. Operative treatment may decrease the frequency of PPC in some fractures. […] The potential complications associated with pediatric ankle fractures include those seen with adult fractures (such as posttraumatic arthritis, stiffness, and reflex sympathetic dystrophy) as well as those that result from physeal damage (including leg-length discrepancy, angular deformity, or a combination thereof). […] The goals of treatment are to achieve and maintain a satisfactory reduction and to avoid physeal arrest. […] Although most pediatric fractures do well, vigilance must be maintained because these injuries may have substantial long-term consequences. Angular deformity and joint incongruity can result in premature degenerative arthritis.

• #2

  https://link.springer.com/article/10.1007/BF02749126

  Injuries to the ankle joint are common. Complete ligament ruptures and fractures of the malleoli and adjacent bones can affect the stability of the ankle joint. If fractures or ligament injuries are present on both sides of the joint, the ankle will usually be unstable. On the other hand, injuries confined to one side of the joint will usually be stable. Unstable ankle joints require operative fixation, whereas stable ankles do well with conservative treatment. Specific ligament injuries precede several fractures. Recognition of the various patterns of injury permits reliable prediction of these ligament injuries. Therefore, it is important for radiologists and others who interpret trauma radiographs to understand the common mechanisms of injury and to recognize these patterns. […] Correct classification of the injury mechanism should lead to prompt, appropriate diagnosis and treatment and should decrease long-term morbidity.

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