Distal fibula fracture, the most common type of ankle fracture, is an isolated malleolar fracture (70% or greater); the majority of these are lateral malleolus fractures. Distal fibula fractures can affect adult patient of any age as well as children. They may be caused by a twisting injury to ankle, a crush injury, or even a direct blow. Distal fibula fracture will present with pain and swelling about lateral aspect of ankle.

Patient recollection of the exact motion of the foot during the injury (supination, pronation, external rotation, internal rotation) often does not reliably correlate with the injury pattern seen on imaging or in the operating room. Therefore, the initial focus should be as follows:

• Get a basic history (eg, whether injury occurred during a fall from a height, a sports activity, or a car accident).
• Perform a thorough physical examination, including assessment for neurovascular deficit.
• Reduce the fracture if necessary (particularly if there is a neurovascular deficit).
• Evaluate x-rays for stability.

Risk factors for ankle fracture include obesity and smoking. Ankle fractures are not classic osteoporotic fractures (ie, bone density is not necessarily protective).

In most cases, patients will present immediately after an injury. Swelling can progress rapidly, and the degree of swelling has a major impact on the timing of surgery and can lead to complications.