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.
Anatomy of the Ankle Joint
The ankle joint is a hinged, synovial joint that moves in one plane to produce dorsiflexion and plantar flexion. The joint is formed by 3 articulating bones: the distal tibia, distal fibula, and the talus. The articular surfaces of the distal tibia and fibula form the ankle mortise, which contains the body of the talus inferiorly. The ankle joint has 3 malleoli: the lateral malleolus of the distal fibula and the medial and posterior malleoli of the distal tibia. The ankle mortise articulation provides ankle joint stability with the body of the talus, ankle syndesmosis, ligaments, and muscles around the ankle joint. The ankle syndesmosis is a fibrous joint connecting the distal tibia and fibula. The syndesmosis is formed by 3 main parts: the interosseous tibiofibular ligament, the anterior inferior tibiofibular ligament, and the posterior inferior tibiofibular ligament. The deltoid ligament originates from the medial malleolus and attaches to the talus, navicular, and calcaneus bones. The deltoid ligament stabilizes the ankle joint against over-eversion. The lateral ligament complex consists of 3 ligaments originating from the lateral malleolus. This ligament attaches to the talus through the anterior and posterior talofibular ligaments and the calcaneus through the calcaneofibular ligament. The lateral ligament complex resists over-inversion. Articular branches of the tibial nerve and the superficial and deep peroneal nerves innervate the ankle joint structures. Branches from the peroneal, anterior, and posterior tibial arteries provide the blood supply to the ankle joint.
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