ankle fracture

Question 1

describe the basic anatomy of an ankle

Answer 1

Question 2

What is the immediate management of ankle fracture?

Answer 2

1. reduce the fracture and support it with a cast
2. assess neurovascular status
3. re do x ray to check reduction
4. Elevation of the ankle is important to allow swelling to settle

Question 3

What is the definitive management of ankle fractures?

Answer 3

1. Open reduction and internal fixation
2. Primary bone healing is important to prevent the form of caluses
3. Absolute stability is required for primary bone healing such as the use of
   - lay screw fixation
   - compression plating
   - buttress plating

Question 4

medial malleolus

Answer 4

the distal end of the tibia

Question 5

lateral mallelos

Answer 5

the distal end of the fibula

Question 6

syndesmosis

Answer 6

a strong fibrous structure which joins the tibia and the fibula

Question 7

what is the definition of an ankle fracture?

Answer 7

fracture of any malleolus - lateral, medial or posterior malleolus with or without disruption at the syndesmosis

Question 8

what is the anatomical classification of an ankle fracture?

Answer 8

isolated lateral malleolar fractures,

isolated medial malleolar fractures,

bimalleolar fractures ( = medial + lateral malleolar fracture)

trimalleolar fractures ( = medial + lateral + posterior malleolar fracture).

Question 9

What is Weber’s classification?

Answer 9

Weber classification, which classifies lateral malleolus fractures:

Type A = below the syndesmosis

Type B = at the level of the syndesmosis

Type C = above the level of the syndesmosis

The more proximal the injury, the higher the likelihood of ankle instability; consequently, Type C fractures almost always need surgical fixation.

Question 10

clinical features of an ankle fracture

Answer 10

ankle pain following a traumatic injury. There may be associated deformity in cases of fracture dislocation

Question 11

Ix

Answer 11

1. AP / lateral X ray

Question 12

Initial Mx

Answer 12

• Initial management requires immediate fracture reduction,

usually performed under sedation in the Emergency Department, to realign the fracture to anatomical alignment.

• Once reduced, the ankle should be placed in a below knee back slab.

You must then repeat and document the post-reduction neurovascular examination.

• Request a repeat plain film radiography; if the reduction is not adequate, repeat reduction attempts are required.

Question 13

When is conservative mx indicated?

Question 14

When is surgical mx indicated?

Answer 14

Open reduction and internal fixation (ORIF) is often required in ankle fractures to achieve stable anatomical reduction of the talus within the ankle mortise.

Ankle fractures that require an ORIF include:

• Displaced bimalleolar or trimalleolar fractures
• Weber C fractures
• Weber B fractures with talar shift
• Open fractures