Fracture Ankle

D: Fracture of bones forming the osseoligamentous mortise of the ankle joint. Unimalleolar fractures involve only one malleolus (usually lateral) (see Fig. 10b). Bimalleolar (Pott) fractures involve two malleoli (usually medial and lateral). ^^ Trimalleolar (Cotton) fractures involve the medial, lateral, and posterior malleoli (posterior lip of articular surface of tibia) (see Fig. 10a). Pilon fractures are those of the distal tibia metaphysis that extend into the ankle joint and are commonly associated with a distal fibula fracture.

A: Trauma (e.g. direct, indirect or rotational), pathological.

A/R: Commonly associated with collateral ligament injuries or ankle subluxation or dislocation, or fractures of the proximal fibula, base of 5th metatarsal, calca-neus or navicular.

Very common.

Enquire in detail about the mechanism of the injury, inversion or eversion injury, whether able to bear weight after the injury, and any history of previous trauma to the ankle.

For presence of an open wound, swelling, erythema, bony tenderness. Assess the range of motion, ligamentous laxity and neurovascular status.

The distal tibia, distal fibula, talus and calcaneus provide the joint framework. Danis-Weber classification of ankle fractures uses the position of the level of the fibular fracture relative to the syndesmosis: Type A: Fracture below the syndesmosis.

Type B: Fracture at the level of the syndesmosis, with the tibiofibular ligaments usually intact.

Type C: Fracture above the syndesmosis, which tears the syndesmosis ligaments. Lauge-Hansen classification uses two-word descriptors: the first describes the position of the foot, and the second describes the motion of the foot (talus) with respect to the leg. Categories include supination-adduction, supination-eversion, pronation-abduction, pronation-eversion and pronation-dorsiflexion.

The Ottawa ankle rules for X-ray include the inability to bear weight immediately after the injury or at the time of presentation, and tenderness over the posterior surface or tip of malleoli.

Radiographs: Should include AP, lateral and mortise views. The fibula should also be imaged if there is proximal fibula tenderness.

Fracture dislocations: Should be reduced and immobilised prior to X-ray to prevent skin necrosis over the medial malleolus.

Closed reduction and splint: For simple uncomplicated lateral malleolar fractures.

Open reduction, internal fixation: Indicated for pilon, bimalleolar and trimalleolar fractures, or lateral malleoli fractures with damage to the deltoid ligament (> 5 mm on X-ray with ankle on eversion).

Open fractures: Should be treated urgently. Protect from further contamination by covering wounds with a wet, sterile dressing secured by loosely wrapped dry sterile gauze. Consider antibiotic prophylaxis, tetanus immunisation. May need temporary external fixation prior to definitive fixation and soft tissue cover. Rehabilitation: Always avoid immobilisation of the ankle in equines. After swelling subsides and evidence of healing, encourage weightbearing.

Non-union or mal-union of the fracture. Chronic persistent symptoms (e.g. pain, weakness and instability of the ankle) may develop. Traumatic arthritis complicates 20-40% of ankle fractures. In children, ankle fractures involving the growth plate may cause chronic deformity with disturbance of growth of the limb.

Isolated, nondisplaced lateral malleolus fracture (the most common ankle fracture) has a favourable prognosis.

Fig. 10 (a) Trimalleolar fracture of the left ankle; (b) fracture of the left medial malleolus.

Fig. 10 (a) Trimalleolar fracture of the left ankle; (b) fracture of the left medial malleolus.

Was this article helpful?

0 0
Natural Arthritis Relief

Natural Arthritis Relief

Natural Arthritis Relief details a unique method of reversing Rheumatoid Arthritis Symptoms by removing numerous arthritis triggers as well as toxins using a simple 5 step natural process.

Get My Free Ebook

Post a comment