Clinical Acute Ankle Injuries in the Urgent Care Setting Urgent message: Working knowledge of anatomy and familiarity with radiograph reading, injury classification, treatment options, and criteria for referral support positive long-term outcomes in patients with acute ankle injuries. Janet D. Little, MD and William E. Saar, DO Introduction cute ankle injury is one of the most com- mon musculoskeletal injuries in the athlete and sedentary person alike. The yearly incidence of ankle injuries varies between resources, but ran- ges from 1 million to 5 mil- lion per year in the United States alone. 1-3 Injuries to the ankle af- fect soft tissue and bone, both of which must be ad- dressed upon presentation to the urgent care setting to avoid long-term complica- tions and to ultimately re- © Bodell Communications / Phototake, Inc. store normal anatomy and functionality. Systemic illness (e.g., diabetes), high body- mass index, smoking, and prior ankle injury 4,5 are all as- sociated risk factors for ankle injuries and must be taken into account, as these may affect overall outcomes. This article will provide a brief overview of ankle sprains, but will focus primarily on acute ankle frac- tures that result from minor trauma, including a basic ap- proach to evaluation, management, and orthopedic re- A w w w. j u c m . c o m ferral of stable versus unsta- ble ankle fractures. Anatomy During ambulation, the an- kle joint must withstand 1.25–5.5 times the normal body weight, depending on the activity. Its motion in- volves dorsi- and plan- tarflexion and internal and external rotation, as well as inversion and eversion be- cause of its proximity to the subtalar joint. 3 A thorough knowledge of the anatomic structures making up the ankle joint helps in the evaluation and manage- ment of acute injuries. The bony anatomy of the ankle consists of the ar- ticulation of the distal tibia—medial malleolus and fibula—and the lateral malleolus with the talus. The posterior aspect of the distal tibia is referred to as the posterior malleolus. The bones are held to- gether by the ligaments of the ankle to form a mor- tise (Figure 1A and Figure 1B). The lateral collateral ligamentous (LCL) complex JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J u l y/A u g u s t 2 0 0 8 13