Ankle Fracture Flashcards
Questions to ask for ankle injury
- Onset
- Location of pain
- Activity at the time
- Weight bearing?
- ROM
- Previous ankle injuries/problems
Examination things to look for for ankle #
- Deformity - higher risk of NV compromise
- Open # - needs debridement and irrigation
- Check Ottawa rules if unsure
What are the Ottawa rules for ankle pain?
Apply if uncertain - eg if patient can mobilise and has no deformity.
X-rays should be taken if any of following apply:
* Bone tenderness at posterior edge or tip of lateral malleolus OR
* Bone tenderness at posterior edge or tip of medial malleolus OR
* Inability to weight bear immediately and in emergency department for 4 steps
Investigations for suspected ankle #
- X-ray - AP lateral and mortise view. Ankle needs to be fully dorsiflexed
- CT if complex or posterior malleolus displaced
DorSI to SEE
Emergency treatment for ankle # in ED
- Immediate reduction of fracture under sedation
- Allows realignment
- Stabilise with below knee back slab
- Document post reduction NV status of limb
How do you check if reduction was adequate?
- Repeat x-ray, if inadequate realignment, repeat
When would patient have surgery for fracture of ankle?
- Displaced bimalleolar or trimalleolar fracture
- Weber class C
- Weber class B with talar shift
- Open fractures
Classification of ankle fractures
- Weber classification - if lateral malleolus
- Lauge Hansen classification - based on ankle position at time of injury, deforming force, much more detailed than Weber
Helly Hansen sounds like wellies - go over ankle
Weber classifcation of fractures
Class A, B and C
More proximal = higher risk of instability
= C often surgically fixation managed
Walking aids given for patient following internal fixation of ankle joint
- Under arm crutches
- Zimmer frame
- Orthopedic boot
- Knee scooter
- Wheelchair
- Assistance for home eg handrails etc
How long before can work and do sport post internal fixation of ankle?
- Work - depends on job
- Sport - 6 weeks of boot, then gradual physio out of boot, standard time is 12 weeks post surgery
When is conservative management used in ankle #? (post reduction)
- Non-displaced medial malleolus #
- Weber A (all) or Weber B fractures without talar shift
- Those unfit for surgical intervention
Complications post ankle #
- Post traumatic arthirtis - rare with adequate treatment of reduction and fixation
Anatomical classification of ankle #
- Lateral malleolus
- Medial malleolus
- Bimalleolar
- Trimalleolar
What keeps ankle joint stable usually?
- Interosseus membrane between tibia and fibula
- Anterior inferior tibiofibular ligament
- Posterior inferior tibiofibular ligament
PITFL - pitfall