Weber C / bi/trimalleolar ankle fracture / dislocations

These are all unstable ankle fracture that require surgical fixation

• Weber C fibular fractures

• bimalleolar fractures

• trimalleolar fractures

Assessment

• Take a detailed history of the mechanism of injury and obtained pre-operative medical history.

• Ensure to look for associated injuries, particularly in high mechanism injuries.

• Check skin integrity to look for open fracture (note that a small in-out puncture wound is still an open fracture) - follow the BOAST open fracture guidelines.

A&E management

The key is early reduction and stabilisation of the fracture.

Reduction often require adequate relaxation of the patient.

Acute management include:

1. strict elevation of the ankle above heart level

2. provide analgesia

3. liaise with A&E resus for sedation and reduction

4. reduce ankle and apply a below knee backslab

5. organise a post-reduction check XR

6. refer to Ortho oncall team to admit patient