The number of fractures determines whether the injury is "bimal" or "trimal." They very often occur in the setting of polytrauma. Think of lateral malleolus fractures with medial deltoid ligament disruption as "bimal-equivalents."
In most cases, patients will present immediately after an injury. Swelling can progress rapidly, and the degree of swelling has a major impact on the timing of surgery and can lead to complications.
With all suspected ankle fractures, it is important to:
- Get a basic history (eg, whether injury occurred during sports activity, a fall from a height, or a car accident).
- Perform a thorough physical examination, including assessment for neurovascular deficit.
- Reduce the fracture if necessary (particularly if there is a neurovascular deficit).
- Evaluate x-rays for stability. NOTE: By definition, these injuries are unstable, as 2 structures are "out."