Question
A 38 year old man falls 3 metres onto his feet. His ankle is swollen with fracture blisters.
- How is this injury classified?
- What is staged management?
- What are the complications?
Answer
Ruedi and Allgower classification
| Type | Description |
|---|---|
| I | Undisplaced articular fracture |
| II | Displaced articular fracture without comminution |
| III | Comminuted and impacted articular fracture |
AO/OTA
- Type 43B is partial articular and 43C complete articular
Staged management
- Spanning external fixator within 24 to 48 hours, with or without fibular fixation
- CT after length is restored
- Definitive fixation when the wrinkle sign returns, usually 7 to 21 days
- Restore fibular length, rebuild the articular surface, graft the metaphyseal void and buttress
- Plan incisions with wide skin bridges
Complications
- Wound breakdown and deep infection
- Post-traumatic arthritis
- Malunion and nonunion
- Compartment syndrome
- Ankle arthrodesis for end stage arthritis
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.