Trauma & OrthopaedicsPending review

Ankle Fracture

The ankle mortise is a ring of bone and ligament around the talus, so a fracture is only unstable if the ring has failed in more than one place, the principle underlying both the Weber classification and the Ottawa ankle rules.

In a nutshell

The ankle mortise is a ring around the talus formed by both malleoli, the syndesmosis and supporting ligaments; a ring rarely breaks in only one place, so stability depends on whether it has failed elsewhere too. The Weber classification tracks fibular fracture level against syndesmosis risk, and the Ottawa ankle rules decide who needs an X-ray at all.

Classic presentation

Ankle pain and swelling with malleolar tenderness after a twisting injury, assessed first with the Ottawa ankle rules to decide whether an X-ray is needed.

Key points

  • The ankle mortise is a closed ring, both malleoli plus the syndesmosis and ligaments; an isolated, undisplaced fracture with the rest of the ring intact is usually stable.

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Educational content pending clinical review. Not medical advice.