Ankle Fractures , Anatomical Considerations - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing fractures of the ankle, anatomical considerations, this video also explains fractures of the ankle X-rays.
It describes ankle fracture classification, ankle fracture dislocation.
It also describes ankle fracture treatment, ankle fracture surgery, and ankle fracture recovery.
The talus is wider anteriorly than posteriorly.
When the ankle dorsiflexes, the fibula rotates externally through the syndesmosis to accommodate the wider anterior part of the talus.
The fibula is connected to the tibia by the interosseous membrane proximally, and then around the ankle you have ligaments:
- The anterior inferior tibiofibular ligament
- Posterior inferior tibiofibular ligament
- Interosseous ligament
These are the ligaments that are involved in the stability of the syndesmosis, responsible for stability of the ankle in external rotation, and they are different from the lateral collateral ligament.
The lateral collateral ligaments that are involved in ankle sprains are:
- Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
These are restrains to the inversion of the ankle and anterior translation of the talus.
Then you have the medial malleolus with a groove for the posterior tibial tendon.
So when posterior collicular fracture occurs, this tendon of the tibialis muscle supports the fracture so the fracture doesn’t displace.
The medial malleolus has 2 collicular parts:
• Anterior colliculus: is about 5mm longer than the posterior colliculus
• Posterior colliculus
The anterior and posterior collicular parts are separated by the intercollicular groove.
The deltoid ligament supplies the medial support to the ankle.
It’s composed of 2 parts:
• The superficial deltoid: arises from the anterior colliculus.
• Deep deltoid: arises from the posterior colliculus and intercollicular groove.
It is an intra-articular ligament that can’t be repaired but we can debride it.
When a fracture in the medial malleolus occurs, it can be one of these types:
• The Supracollicular fracture: above both of the anterior and posterior colliculus, plus the deep deltoid ligament.
• Anterior collicular fracture
When fracture of the medial malleolus occurs, it can be one of these types:
• The supracollicular fracture: above both the anterior and posterior colliculus
• Anterior collicular fracture: involves anterior colliculus alone, or involves anterior colliculus plus the deep deltoid ligament.
• Posterior colliculus fracture: needs an external rotation to see, it’s an AP external rotation view which is different from the posterior malleolus fracture which you get lateral external rotation view.

If you have a vertical fracture of the medial malleolus which is supination and adduction, make sure you don’t have anterior medial marginal impaction.
Make sure you put the screws parallel to the joint or use anti-glide plate.
If you have an anterior intercollicular fracture, the fragment may be too small to fix with screws and you may want to use tension band technique.
If it is posterior collicular, it’s probably stable, you may not need to fix.
If it is supracollicular you probably need to use the screws that you use routinely, which is perpendicular to the fracture, and make sure they are not being placed inside the joint by getting an AP view of the ankle itself.
The Nerves around the ankle:
1- The Saphenous nerve: is at risk of injury when you fix the medial malleolus, its usually superior and anterior to the tip of the medial malleolus.
2- The Superficial Peroneal nerve: it crosses from the lateral to the anterior compartment and this crossing may vary, and its vulnerable to injury during lateral plating of the fibula, it crosses the ankle anterior to the fibula and it is usually about 10 cm from the fibula tip, and it runs above the extensor retinaculum.
3- The Sural nerve: it’s vulnerable to injury distally, especially when you do posterolateral plating or posterior plating of the fibula, and the superior peroneal retinaculum also could be injured when you do posterior plating of the fibula.
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