Controversies in ankle fractures.

Abstract

With the advent of modern techniques of stable internal fixation, ankle fractures have become one of most the successfully treated fractures. The underlying concepts governing the choice of treatment for ankle fractures revolve around the notion of ankle stability. The seminal observations of Ramsey and Hamilton3’ and Yablon et aL50 have provided the central tenets around which rational treatment of ankle fractures is based. In this view, the key to stability of the ankle is the position of the lateral malleolus, particularly when there are medial side injuries. Despite the advancement in operative techniques, our understanding of the pathologic anatomy of ankle fractures and of the normal and posttraumatic kinematics of the ankle is incomplete. As a consequence, there are some significant differences of opinion concerning particular fracture patterns and the criteria for surgical intervention. The goal of this review was to touch briefly upon those areas of general agreement while highlighting those issues which continue to give rise to extended debate.