Ankle fractures are very common injuries and have the whole spectrum of injuries. Few images of x-rays of ankle fractures are presented below
Image 1 – Bimalleolar Fracture With Tibiofibular Diastasis
Following Xray belongs to a man 29 years old male with motor vehicle accident which got his ankle injury.
Note the separation of the tibia and fibula [diastasis] represented by increased space between the two. The fracture of the fibula is quite high.
There is a subluxation of the ankle as well.
Image 2 – Trimalleolar Fracture WIth Tibial Shaft Fracture
33 years old young swelling on the leg male got injured in a motor vehicle accident and presented to emergency with an inability to bear weight on the leg.
On assessment, there were no injuries to any other part and his neurovascular status of the injured limb was normal.
The x-rays of ankle revealed a trimalleolar fracture and a fracture line that extended up to the tibial shaft.
In above x-ray, anteroposterior view of the ankle is seen. Fractures are marked. Posterior malleolus cannot be seen in this view but the fractured posterior malleolus has been marked in the lateral view below.
The patient was advised open reduction and internal fixation for the fractures including tibial fracture.
The patient however refused and decided to try some form of alternative therapy instead.
Image 3 – Xray of Fracture Talus with Ipsilateral Tibia Lower End Fracture
Xray of fracture Talus with concomitant ipsilateral tibia lower end fracture
Such fractures are difficult to treat and talus is prone to osteonecrosis in spite of reduction.
Image 4 -Xray of Fracture Fibula With Subluxation of Ankle
Subluxation of ankle caused by injury to ankle and fracture of the fibula. The Xray that follows shows displaced fracture of fibula with subluxation of ankle joint. On left is anteroposterior view and on right is lateral view.
This patient suffered injury after he tried to get down from a moving bus. His ankle got twisted and that resulted in injury. He was taken to the hospital where he was evaluated and a splint was applied. The shadow of the splint is visible in Xray.
Anteroposterior View Xray of Fracture Fibula With Subluxation of Ankle
This is view on the left side and shows a fracture in fibula (upper arrow) and subluxation of the ankle which is depicted by increased joint space in the ankle (lower arrow). There is no fracture of medial malleolus visible.
Lateral View Xray of Fracture Fibula With Subluxation of Ankle
This is on the right side and shows fracture fibula (upper arrow). Joint space cannot be commented upon because the x-ray does not show it.
But there appears a fracture of the cuboid in the foot (lower arrow). This fracture is not visible in the other view because of overlapping shadows of other bones of the foot. We need an anteroposterior view of the foot to ascertain that.
This injury has resulted from twisting force to ankle. In such cases of injury, the usual result is bimalleolar fracture i.e. Fibula, as well as medial malleolus, are fractured. However, in fewer cases, the deltoid ligament (Ligament that connects tibia to talus bone on the foot. This ligament is quite important in maintaining the stability of the ankle joint.) breaks earlier and medial malleolus is spared.
Because the injury is to lateral as well as medial structures, this has resulted in instability of ankle joint, which is visible as subluxation.
Fracture of the cuboid bone might have resulted from the impact of the foot on the ground as the foot struck it.
Image 5 – Xrays of Bimalleolar Fracture With Ankle Dislocation
Bimalleolar fracture is a fracture in which both the malleoli of the ankle are presented. Bimalleolar fracture with ankle dislocation occur but are not very common.
Following are pre and post-treatment x-rays of a patient with bimalleolar fracture with ankle dislocation.
This is a case of 40 years old male patient who sustained injury after fall from moving bike. He was presented to emergency with severe pain and swelling in the x-ray region.
This x-ray contains anteroposterior view on the left side and lateral view on the right side.
You can see fracture medial and lateral malleoli along with dislocation of the ankle.
The patient was operated. The fibula was fixed with a one-third tubular plate and medial malleolus was treated by tension band wiring. The ankle was reduced and was stable.
The fractures are well reduced in both the views and a joint line is well maintained.
Image 6 – Osteochondral Fracture Of Talus – Anteroposterior Xray
A small fracture line is visible in the upper outer part of the dome of the talus. If you cannot localize it, look at the center of the circle.
The image has been contributed by Tom Jankowski, a reader of Bone and Spine.
Image 7 – Anteroposterior and Lateral Views Of Bimalleolar Fracture of Ankle
Xrays of bimalleolar fracture, AP and lateral views in 27 years old active male.
The fibula was fixed with one-third tubular plate using open reduction and internal fixation. Medial malleolus was reduced closed and fixed with malleolar screws under Carm image intensifier.
Image 8 – Xray of Injured Ankle Showing Lateral Malleolus Fracture With Subluxation Of Ankle
Following are anteroposterior and lateral views of an ankle injury showing a fracture of lateral malleolus in an adult along with subluxation of ankle..
Here is the anteroposterior xray showing the fracture and increased joint space on the medial side [marked by arrow] indicating subluxation
Here is the lateral view
Such injuries are best managed by open reduction and internal fixation. Restoration of fibular length would automatically reduce the ankle joint as well.
Image 9 – Operated Bimalleolar Fracture With Malleolar Screws and One Third Tubular Plate
Bimalleolar fracture fixed with malleolar screws for medial malleolus fracture and one-third tubular plate for fibular fracture.
The x-ray was taken after 3 weeks of surgery.
Image 10 – Xray of Fracture of Lateral Malleolus
Lateral malleolus is an extension of fibula beyond the ankle joint.
It can be fractured in direct trauma or twisting injuries of the ankle.
It is usually accompanied by ligamentous injuries on the medial side or fracture of the medial malleolus.
The x-ray shows an undisplaced fracture of lateral malleolus in 34-year-old man which resulted following a twisting injury to the ankle.
One of the concerns in malleolar fractures is subluxation of the ankle joint which may result if the fracture is displaced.
An undisplaced fracture of lateral malleolus is very well treated by nonoperative methods.
Image 11 – Xray of Dislocation of Ankle
Xray of ankle, lateral view, showing dislocation of an ankle.
The injury occurred following fall from stairs.
The dislocation was reduced under sedation and splint was applied.
Image 13 – Nimalleolar fracture treated with Malleolar Screws and Tension Band Wiring
Xray of bimalleolar fracture of the ankle. Here is the x-ray after the injury that shows a fracture of the medial malleolus and lateral malleolus.
The fracture was operated and fixed using a malleolar screw for medial malleolus and tension band wiring for lateral malleolus.
Here is anteroposterior view.
This is the lateral view.
The fractures are well reduced and joint space is well maintained.
Image 14 – Fracture Lateral Malleolus With Subluxation of Ankle
Xray of 54 years old male with an ankle injury
The x-ray shows a fracture of lateral malleolus with subluxation of ankle joint.
The fracture has been marked by an arrow. Widening of medial joint space is also shown with an arrow.
Image 15 – Ankle X-rays showing an operated bimalleolar fracture
Following ankle x-rays belong to 51 years old male who broke his ankle and got a bimalleolar fracture. Xrays of the broken ankle showed displaced fibula and medial malleolus fracture.
The patient had soft tissue swelling and was put on splint waiting for surgery. The patient developed blisters and could be operated only after 15 15 days of initial injury.
The patient was operated with plating for fracture fibula and malleolar screws for medial malleolus.
The postoperative period was uneventful.
The fracture united and weight bearing was established after 10 weeks of surgery.