Ankle Fracture Management in the ED Differential Diagnoses

1. Ribeiro de Ávila V, Bento T, Gomes W, et al. Functional outcomes and quality of life after ankle fracture surgically treated: a systematic review. J Sport Rehabil. 2018 May 1. 27 (3):274-83. [QxMD MEDLINE Link].

2. Wire J, Hermena S, Slane VH. Ankle fractures. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].

3. Hinds RM, Garner MR, Lazaro LE, et al. Ankle fracture spur sign is pathognomonic for the hyperplantarflexion variant ankle fracture. Foot Ankle Int. 2015 Feb. 36 (2):159-64. [QxMD MEDLINE Link].

4. Yavas S, Arslan ED, Ozkan S, et al. Accuracy of Ottawa Ankle Rules for midfoot and ankle injuries. Acta Biomed. 2021 Sep 2. 92 (4):e2021241. [QxMD MEDLINE Link].

5. Scheer RC, Newman JM, Zhou JJ, et al. Ankle fracture epidemiology in the United States: patient-related trends and mechanisms of injury. J Foot Ankle Surg. 2020 May - Jun. 59 (3):479-83. [QxMD MEDLINE Link].

6. Parikh SN, Mehlman CT. The community orthopaedic surgeon taking trauma call: pediatric ankle fracture pearls and pitfalls. J Orthop Trauma. 2017 Nov. 31 Suppl 6:S27-S31. [QxMD MEDLINE Link].

7. McKissack HM, Viner GC, McMurtrie JT, et al. Does insurance status affect access to care among ankle fracture patients? An institutional retrospective study. J Foot Ankle Surg. 2021 May-Jun. 60 (3):520-2. [QxMD MEDLINE Link].

8. Van Schie-Van der Weert EM, Van Lieshout EM, De Vries MR, et al. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg. 2012 Feb. 132(2):257-63. [QxMD MEDLINE Link]. [Full Text].

9. Han SM, Wu TH, Wen JX, et al. Radiographic analysis of adult ankle fractures using combined Danis-Weber and Lauge-Hansen classification systems. Sci Rep. 2020 May 6. 10 (1):7655. [QxMD MEDLINE Link].

10. Duchesneau S, Fallat LM. The Tillaux fracture. J Foot Ankle Surg. 1996 Mar-Apr. 35(2):127-33; discussion 189. [QxMD MEDLINE Link].

11. McCrory P, Bladin C. Fractures of the lateral process of the talus: a clinical review. "Snowboarder's ankle.". Clin J Sport Med. 1996 Apr. 6(2):124-8. [QxMD MEDLINE Link].

12. Chan GM, Yoshida D. Fracture of the lateral process of the talus associated with snowboarding. Ann Emerg Med. 2003 Jun. 41(6):854-8. [QxMD MEDLINE Link].

13. Ojeda-Jiménez J, Méndez-Ojeda MM, Martín-Vélez P, et al. Experience using the "Shetty test" for initial foot and ankle fracture screening in the emergency department. Rev Esp Cir Ortop Traumatol (Engl Ed). 2018 Sep-Oct. 62 (5):343-7. [QxMD MEDLINE Link].

14. Dowdall H, Gee M, Brison RJ, et al. Utilization of radiographs for the diagnosis of ankle fractures in Kingston, Ontario, Canada. Acad Emerg Med. 2011 May. 18(5):555-8. [QxMD MEDLINE Link].

15. [Guideline] Dalinka MK, Alazraki NP, Daffner RH, et al; Expert Panel on Musculoskeletal Imaging. Suspected ankle fractures. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. [Full Text].

16. Mosher TJ, Kransdorf MJ, Adler R, et al. ACR Appropriateness Criteria acute trauma to the ankle. J Am Coll Radiol. 2015 Mar. 12 (3):221-7. [QxMD MEDLINE Link].

17. Broomhead A, Stuart P. Validation of the Ottawa Ankle Rules in Australia. Emerg Med (Fremantle). 2003 Apr. 15(2):126-32. [QxMD MEDLINE Link].

18. David S, Gray K, Russell JA, et al. Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries. J Sport Rehabil. 2016 Feb. 25 (1):48-51. [QxMD MEDLINE Link].

19. Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009 Apr. 16(4):277-87. [QxMD MEDLINE Link].

20. Petscavage J, Baker SR, Clarkin K, et al. Overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries. Emerg Radiol. 2010 Jul. 17 (4):261-5. [QxMD MEDLINE Link].

21. Gonzalez O, Fleming JJ, Meyr AJ. Radiographic assessment of posterior malleolar ankle fractures. J Foot Ankle Surg. 2015 May-Jun. 54 (3):365-9. [QxMD MEDLINE Link].

22. Fokin A Jr, Huntley SR, Summers SH, et al. Computed tomography assessment of peroneal tendon displacement and posteromedial structure entrapment in pilon fractures. J Orthop Trauma. 2016 Nov. 30 (11):627-33. [QxMD MEDLINE Link].

23. Tollefson B, Nichols J, Fromang S, et al. Validation of the sonographic Ottawa Foot and Ankle Rules (SOFAR) study in a large urban trauma center. J Miss State Med Assoc. 2016 Feb. 57 (2):35-8. [QxMD MEDLINE Link].

24. Alioto RJ, Furia JP, Marquardt JD. Hematoma block for ankle fractures: a safe and efficacious technique for manipulations. J Orthop Trauma. 1995 Apr. 9(2):113-6. [QxMD MEDLINE Link].

25. Barnett PL, Lee MH, Oh L, et al. Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial. Pediatr Emerg Care. 2012 Aug. 28(8):745-9. [QxMD MEDLINE Link].

26. Mora S, Zalavras CG, Wang L, et al. The role of pulsatile cold compression in edema resolution following ankle fractures: a randomized clinical trial. Foot Ankle Int. 2002 Nov. 23(11):999-1002. [QxMD MEDLINE Link].

27. Okcu G, Yercan HS. Is it possible to decrease skin temperature with ice packs under casts and bandages? A cross-sectional, randomized trial on normal and swollen ankles. Arch Orthop Trauma Surg. 2006 Dec. 126(10):668-73. [QxMD MEDLINE Link].

28. Jensen CM, Serritslev R, Abrahamsen C. Patients' perspective on treatment and early rehabilitation after an ankle fracture: a longitudinal qualitative study. Int J Orthop Trauma Nurs. 2021 Oct 29. 100916. [QxMD MEDLINE Link].

29. [Guideline] Ottawa Hospital Research Institute. Ottawa Ankle Rules for ankle injury radiography. Available at http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf. 2013; Accessed: October 26, 2016.

30. Yeung DE, Jia X, Miller CA, et al. Interventions for treating ankle fractures in children. Cochrane Database Syst Rev. 2016 Apr 1. 4:CD010836. [QxMD MEDLINE Link].

31. Shariff SS, Nathwani DK. Lauge-Hansen classification--a literature review. Injury. 2006 Sep. 37(9):888-90. [QxMD MEDLINE Link].

32. Michelson JD, Magid D, McHale K. Clinical utility of a stability-based ankle fracture classification system. J Orthop Trauma. 2007 May. 21(5):307-15. [QxMD MEDLINE Link].

33. Ashworth MJ, Patel N. Compartment syndrome following ankle fracture-dislocation: a case report. J Orthop Trauma. 1998 Jan. 12(1):67-8. [QxMD MEDLINE Link].

34. Birrer R, Cartwright T, Denton J. Immediate diagnosis of ankle trauma. The Physician and Sports Medicine. McGraw Hill; 1994. Vol 22: 95-103.

35. Bucholz RW, Heckman JD. Fractures in adults. Rockwood and Green's Fractures in Adults. 5th ed. Lippincott Williams & Wilkins; 2001.

36. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem?. Acta Orthop Scand. 1998 Feb. 69(1):43-7. [QxMD MEDLINE Link].

37. Cummings RJ, Hahn GA. The incisural fracture. Foot Ankle Int. 2004 Mar. 25(3):132-5. [QxMD MEDLINE Link].

38. Daffner RH. Ankle trauma. Radiol Clin North Am. 1990 Mar. 28(2):395-421. [QxMD MEDLINE Link].

39. Derksen RJ, Bakker FC, Geervliet PC, et al. Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses. Am J Emerg Med. 2005 Oct. 23(6):725-9. [QxMD MEDLINE Link].

40. Duke Orthopaedics. Ankle Fractures. Wheeless' Textbook of Orthopaedics online. 2005. [Full Text].

41. Fox A, Wykes P, Eccles K, et al. Five years of ankle fractures grouped by stability. Injury. 2005 Jul. 36(7):836-41. [QxMD MEDLINE Link].

42. Greenfield DM, Eastell R. Risk factors for ankle fracture. Osteoporos Int. 2001. 12(2):97-103. [QxMD MEDLINE Link].

43. Holroyd BR, Wilson D, Rowe BH, et al. Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules. Am J Emerg Med. 2004 May. 22(3):149-55. [QxMD MEDLINE Link].

44. Kannus P, Palvanen M, Niemi S, et al. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone. 2002 Sep. 31(3):430-3. [QxMD MEDLINE Link].

45. Kirkpatrick DP, Hunter RE, Janes PC, et al. The snowboarder's foot and ankle. Am J Sports Med. 1998 Mar-Apr. 26(2):271-7. [QxMD MEDLINE Link].

46. Koury SI, Stone CK, Harrell G, et al. Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care. 1999 Feb. 15(1):37-9. [QxMD MEDLINE Link].

47. Koval KJ, Lurie J, Zhou W, et al. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma. 2005 Oct. 19(9):635-9. [QxMD MEDLINE Link].

48. Koval KJ, Zhou W, Sparks MJ, et al. Complications after ankle fracture in elderly patients. Foot Ankle Int. 2007 Dec. 28(12):1249-55. [QxMD MEDLINE Link].

49. Martin AG. Weber B ankle fracture: an unnecessary fracture clinic burden. Injury. 2004 Aug. 35(8):805-8. [QxMD MEDLINE Link].

50. Muthukumar T, Butt SH, Cassar-Pullicino VN. Stress fractures and related disorders in foot and ankle: plain films, scintigraphy, CT, and MR Imaging. Semin Musculoskelet Radiol. 2005 Sep. 9(3):210-26. [QxMD MEDLINE Link].

51. Nugent PJ. Ottawa Ankle Rules accurately asses injuries and reduce reliance on radiographs. J Fam Pract. 2004 Oct. 53(10):785-8. [QxMD MEDLINE Link].

52. Park JW, Kim SK, Hong JS, et al. Anterior tibiofibular ligament avulsion fracture in weber type B lateral malleolar fracture. J Trauma. 2002 Apr. 52(4):655-9. [QxMD MEDLINE Link].

53. Perry JJ, Stiell IG. Impact of clinical decision rules on clinical care of traumatic injuries to the foot and ankle, knee, cervical spine, and head. Injury. 2006 Dec. 37(12):1157-65. [QxMD MEDLINE Link].

54. Ruiz E, Cicero J. Emergency Management of Skeletal Injuries. 1st ed. Mosby-Year Book, Inc; 1995. 517-41.

55. Schmittenbecher PP. What must we respect in articular fractures in childhood?. Injury. 2005 Feb. 36 Suppl 1:A35-43. [QxMD MEDLINE Link].

56. Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa Ankle Rules. JAMA. 1994 Mar 16. 271(11):827-32. [QxMD MEDLINE Link].

57. Tang CW, Roidis N, Vaishnav S, et al. Position of the distal fibular fragment in pronation and supination ankle fractures: a CT evaluation. Foot Ankle Int. 2003 Jul. 24(7):561-6. [QxMD MEDLINE Link].

58. Thordarson DB. Detecting and treating common foot and ankle fractures: Part 1: The ankle and hindfoot. Phys Sportsmed. 1996 Sep. 24 (9):

59. Werner CM, Lorich DG, Gardner MJ, et al. Ankle fractures: it is not just a "simple" ankle fracture. Am J Orthop. 2007 Sep. 36(9):466-9. [QxMD MEDLINE Link].

60. Wexler RK. The injured ankle. Am Fam Physician. 1998 Feb 1. 57(3):474-80. [QxMD MEDLINE Link].

Kara Iskyan, MD Staff Physician, Departments of Internal Medicine and Emergency Medicine, Allegheny General Hospital

Kara Iskyan, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Andrew A Aronson, MD, FACEP Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Jerome FX Naradzay, MD, to the development and writing of this article.

• Print this section
• Print the entire contents of
• Print the entire contents of article