Michelson's 2003 narrative review synthesizes the biomechanical and clinical evidence governing ankle fracture management, with a focus on distinguishing stable from unstable injury patterns and providing specific decision-making criteria for posterior malleolar fixation, syndesmotic stabilization, and surgical indications in high-risk patients.
When evaluating an ankle fracture, the presence or absence of medial injury — not the fibular fracture level alone. Determines instability and drives your treatment decision; use the medial clear space versus superior clear space comparison as your primary radiographic instability criterion.
Apply the 30%/>2 mm rule for posterior malleolar fixation from intraoperative films only, and consider a gravity stress view when you have medial tenderness without talar shift on standard films.
Michelson's 2003 narrative review synthesizes the biomechanical and clinical evidence governing ankle fracture management, with a focus on distinguishing stable from unstable injury patterns and providing specific decision-making criteria for posterior malleolar fixation, syndesmotic stabilization, and surgical indications in high-risk patients.
When evaluating an ankle fracture, the presence or absence of medial injury — not the fibular fracture level alone. Determines instability and drives your treatment decision; use the medial clear space versus superior clear space comparison as your primary radiographic instability criterion.
Apply the 30%/>2 mm rule for posterior malleolar fixation from intraoperative films only, and consider a gravity stress view when you have medial tenderness without talar shift on standard films.