title: The pattern of ankle fractures sustained by outdoor activities at the Snowdonia National Park, North Wales, United Kingdom.
abstract: OBJECTIVE
  The aim of this study was to review the pattern of ankle fractures sustained by patients brought to the Emergency Department at Ysbyty Gwynedd from The Snowdonia National Park.
  
  
  METHODS
  The study group included all patients with ankle fractures on the mountain medicine database between March 2004 and December 2006. The presence of talar shift and comminution of the medial malleolus was noted. The pattern of fractures were analysed and compared with the literature. Radiographs were obtained for 20 casualties.
  
  
  RESULTS
  70% of these were injured whilst hill walking. Open fractures represented 12% of injuries. 75% of fractures required operative fixation. Weber B injuries were the commonest followed by Weber C and A. Talar shift was seen in 80% of the cases and 45% showed comminution of the medial malleolus.
  
  
  CONCLUSIONS
  In our case series we observed a high proportion of open and unstable ankle fractures, with the majority treated by operative fixation. The high rate of comminution of the medial malleolus has previously not been reported in the literature and has the potential of making operative fixation technically difficult. Encouraging the use of walking poles particularly at the time of descending may help to reduce the incidence of ankle fractures in hill walkers.
authors.affiliation: Trauma &Orthopaedics-All Wales, Ysbyty Gwynedd, Bangor, North Wales, UK. ajshyamkumar@hotmail.co.uk
authors.forename: A J Shyam
authors.initials: AJ
authors.lastname: Kumar
authors.forename: D S
authors.initials: DS
authors.lastname: Gill
authors.forename: C
authors.initials: C
authors.lastname: Fairweather
authors.forename: L
authors.initials: L
authors.lastname: Dykes
mesh_terms: D000293:Adolescent; D000328:Adult; D000401:Aircraft; D016512:Ankle Injuries / Q000453:epidemiology* / Q000601:surgery; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery; D005597:Fractures, Open / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D014852:Wales; D055815:Young Adult