Ankle fractures mostly occur after sprains of the ankle caused by indirect violence. Depending on the direction and size of the violence and the position of the foot at the time of injury, different types of fractures can be caused. Sometimes complex fractures of the ankle occur as a result of direct violence. I. Classification The common clinical classification methods are Lange-Hansen classification and Davis-Weber classification and AO classification. The Lange-Hansen classification was introduced in 1950 and typed fractures according to the position of the foot at the time of injury and the direction of the violence. It was the first modern classification of ankle fractures (Table). It is instructive for the closed reduction of unstable fractures of the ankle joint. However, due to the complexity of this classification, there are difficulties in its wide clinical application, and in addition, it is sometimes difficult to describe the fractures seen in the classified clinic. Davis-Weber classification. According to the location of the external ankle fracture, the ankle fracture can be classified into A, B, and C types. The classification is simpler and easier to use. However, it cannot account for the various complex changes in the entire ankle joint. The International Academy of Trauma (AO) further refined the Davis-Weber classification and proposed the AO classification: Type A: injury below the level of the inferior tibiofibular union Type A1: simple injury, which can be further divided into (1) rupture of the lateral collateral ligament (2) avulsion fracture of the external ankle tip (3) transverse fracture of the external ankle Type A2: Type A1 plus medial ankle fracture Type A3: Type A1 plus posterior medial fracture of the medial ankle and distal tibia. Type B: Fracture of the fibula via the inferior tibiofibular union Type B1: simple lateral injury, (1) simple fracture (2) with rupture of the anterior inferior tibiofibular ligament (3) comminuted fracture Type B2: Type B1 plus medial injury, (1) simple fibular fracture with rupture of the medial collateral ligament and anterior inferior tibiofibular ligament (2) simple fibular fracture with medial ankle fracture and rupture of the anterior tibiofibular ligament (3) comminuted fibular fracture combined with medial injury Type B3 Type B2: Type B2 plus Volkman fracture, (1) simple fibular fracture with medial collateral ligament (2) simple fibular fracture with medial ankle fracture (3) comminuted fibular fracture combined with medial ankle fracture Type C: injury above the lower tibiofibular union Type C1: simple fibular stem fracture, (1) with medial collateral ligament rupture (2) with medial ankle fracture (3) with medial ankle fracture and Volkman fracture or Duputren Fracture Type C2: Comminuted fibular stem fracture, (1) with medial collateral ligament rupture (2) with medial ankle fracture (3) with medial ankle fracture and Volkman fracture or Duputren fracture Type C3: Proximal fibular fracture, (1) without shortening and no Volkman fracture (2) with shortening and no Volkman fracture (3) with medial injury and Volkman fracture II. Clinical manifestations and diagnosis After ankle trauma, the ankle is painful, swollen, subcutaneous ecchymosis and bruising may appear, and the ankle is afraid to move and cannot walk. On examination, the ankle joint is deformed and there is obvious pressure pain in the inner or outer ankle, and there may be bone rubbing sound. X-rays should be taken of the frontal and lateral ankle joint and ankle points. It is not difficult to diagnose the fracture based on the history of trauma, painful swelling deformity of the ankle and X-ray performance. However, in the case of ankle injury, sometimes a high fracture of the fibular neck occurs and should be examined with care to avoid missing the diagnosis. In the case of a high external ankle or fibular fracture, attention should be paid to evaluating the possibility of an injury to the lower tibiofibular joint (Figure 10-12-3). In addition, other combined injuries such as peripheral ligament injuries, peroneal tendon, Achilles tendon, posterior tibial tendon injuries, osteochondral injuries of the talus, nerve and vascular injuries, etc. should be examined. Treatment of ankle fractures (a) Non-surgical treatment For fractures without displacement. It can be fixed in a cast or brace for 4-6 weeks (Figure 10-12-5) and a rehabilitation program can be started. (ii) Surgical treatment is indicated for displaced fractures. The aim of treatment is to restore the normal anatomy and maintain the fracture in place during the healing process, to start functional activities as early as possible and to restore the function of the ankle joint. After the fracture is repositioned, the inner ankle is mostly fixed with screws or tension band wires, and the outer ankle is mostly fixed with plates and screws. If the ankle fracture is combined with separation of the lower tibiofibular joint. After fixation of the fracture, for the instability of the lower tibiofibular joint that is still present, it is necessary to start the rehabilitation program after the fixation surgery of the lower tibiofibular.