--- title: "\"Not so simple\" ankle fracture: improve patient outcomes. | Sutter Health" description: "A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes." url: "https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. "Not so simple" ankle fracture: improve patient outcomes. # The "not so simple" ankle fracture: avoiding problems and pitfalls to improve patient outcomes. Hak DJ, Egol KA, Gardner MJ, & Haskell A. _Instr Course Lect. 60:73-88._ 2011-01-01 ## Abstract Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/21553763) ![Andrew Haskell, M.D.](https://dyn.mktgcdn.com/p/e19Z0QwiEJVIawTe_Uey_VlyYexupaSsdn87lO6XoJk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Andrew Haskell, M.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/andrew-haskell-md-1049681101) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Musculoskeletal Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Musculoskeletal+Disorders%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Vibration and pressure wave therapy for calf strains: a proposed treatment.](https://www.sutterhealth.org/research/publications/vibration-pressure-wave-tx-calf-strains-1055312323) Saxena A, St Louis M, Fournier M. Muscles Ligaments Tendons J. 3(2):60-2. doi: 10.11138/mltj/2013.3.2.060. Print 2013 Apr. 2013 Jul 09 - Publication ### [Percutaneous plating of Weber B fibular fractures.](https://www.sutterhealth.org/research/publications/percutaneous-plate-weber-b-fibula-fx-1055312373) Saxena A, Yun A. J Foot Ankle Surg. pii: S1067-2516(16)30393-3. doi: 10.1053/j.jfas.2016.11.012. \[Epub ahead of print\] 2017 Jan 12 - Publication ### [Fixation of osteoporotic distal fibula fractures: A biomechanical comparison of locking versus conventional plates.](https://www.sutterhealth.org/research/publications/fixation-osteoporotic-distal-fibula-fx-1055312983) Kim T, Ayturk UM, Haskell A, Miclau T, Puttlitz CM. J Foot Ankle Surg. 46(1):2-6. 2007 Jan 01 - Publication ### [Peritenolysis and debridement for main body (mid-portion) Achilles tendinopathy in athletic patients: results of 107 procedures.](https://www.sutterhealth.org/research/publications/peritenolysis-debridemt-achilles-tendinopathy-1055312289) Saxena A, Hong BK, Hofer D. J Foot Ankle Surg. pii: S1067-2516(17)30271-5. doi: 10.1053/j.jfas.2017.04.020. \[Epub ahead of print\] 2017 May 31 - Publication ### [Stabilization of the fourth metatarsal-cuboid lateral Lisfranc injury: early results of an innovative technique using suture anchors.](https://www.sutterhealth.org/research/publications/suture-anchors-to-stabilize-lisfranc-injury-1055312372) Saxena A, Hofer D. J Foot Ankle Surg. pii: S1067-2516(17)30537-9. doi: 10.1053/j.jfas.2017.08.024. \[Epub ahead of print\] 2017 Dec 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"\"Not so simple\" ankle fracture: improve patient outcomes."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981#medicalscholarlyarticle","name":"The \"not so simple\" ankle fracture: avoiding problems and pitfalls to improve patient outcomes.","headline":"\"Not so simple\" ankle fracture: improve patient outcomes.","abstract":"Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes.","description":"A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes.","keywords":["Disease Management","Musculoskeletal Disorders"],"datePublished":"2011-01-01","url":"https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"21553763"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/21553763/"],"isPartOf":{"@type":"Periodical","name":"Instr Course Lect"},"author":[{"@type":"Person","name":"Hak DJ"},{"@type":"Person","name":"Egol KA"},{"@type":"Person","name":"Gardner MJ"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/andrew-haskell-md-1049681101","name":"Haskell A","url":"https://www.sutterhealth.org/research/investigators/andrew-haskell-md-1049681101"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Musculoskeletal Disorders","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Musculoskeletal+Disorders%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/complex-ankle-fx-pt-outcomes-1055312981#breadcrumblist"}}} ```