Ankle Injuries - Summary

Step 1 - ABCs
Step 2 - Vascular
Step 3 - Mechanism for ankle
Step 4 - Other structures
PEARLS

Clinical Pathways – Suspected ankle injury

Step 1 - ABC’s 

• Treat life threatening injuries 
• Provide analgesia 

Step 2 - Vascular 

• Signs of vascular compromise 
• Reduce fracture / dislocation 
• Immobilise / Reassess post reduction 
• Elevate / Orthopaedic consult 

Step 3 - Mechanism for ankle

• Do ankle series 
• Inversion injury (Lateral ligament sprain, lateral mallelous avulsion or bi-malleolar fracture) 
• Eversion / External rotation (medial / syndesmosis sprain, medial- or bi-malleolar fracture, proximal fibula fracture) 
• Axial loading (pilon fracture, Achilles tendon rupture) 

Step 4 – Other structures 

• Proximal fibula tender order dedicated knee films 
• 5th Metatarsal or Navicular bone tenderness order foot films 
• Positive squeeze test (syndesmosis sprain) 

PEARLS 

Basic ankle fracture management : 

1. Analgesia 
2. Reduce ankle to neutral position and immobilise with either a posterior splint or stirrup splint or both. 
3. Elevate the ankle 
4. Appropriate follow up and referral depending on the injury sustained.