Ankle fractures constitute a considerable part of the trauma surgeon's workload. Although many injuries are straightforward, a high proportion merit surgical intervention. Decision-making depends on recognition of the fracture pattern and its associated ligament injuries. An understanding of the mechanism of injury helps fracture diagnosis as this enables prediction of damaged structures. Fractures in the elderly present difficulties in dealing with poor bone quality, but by modification of technique satisfactory results may be obtained. The mechanism and management of ankle fractures is discussed including current controversies, open fractures and post-traumatic osteoarthritis.
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