Ankle Fractures

Question 1

What is an Ankle #? (2 things)

Answer 1

1. # of any malleolus (lat / med / post)
2. +/- disruption of syndesmosis

Question 2

What is the Syndesmosis?

Answer 2

Strong fibrous structure where Tibia + Fibula join

Question 3

What is the syndesmosis made up of? (3 things)

Answer 3

1. Ant. Inf. Tibiofibular Lig (AITFL)
2. Post Inf. Tibiofibular Lig (PITFL)
3. Intra-osseous memb.

Question 4

How are Ankle # anatomically described? (4 things)

Answer 4

1. Isolated lat malleolar #
2. Isolated med malleolar #
3. Bimalleolar # (lat + med)
4. Trimalleolar # (lat + med + post)

Question 5

What is the classification system of LATERAL malleolar Ankle #s?

Answer 5

Weber classification

Question 6

What are the groups in Weber classification of lat malleolar #s? (3 things)

Answer 6

1. Weber A = # below syndesmosis
2. Weber B = # @ level of syndesmosis
3. Weber C = # above syndesmosis

Question 7

Which Weber classification # needs surgical fixation?

Answer 7

Weber C bc more likely to have syndesmosis ligament disruption –> more ankle instability

Question 8

What are the clinical features of Ankle #s? (3 things)

Answer 8

1. Pain
2. Gross swelling (can delay surgery)
3. Can be very deformed open # w. neurovasc compromise

Question 9

What should you LOOK for in examination of an Ankle #? (4 things)

Answer 9

1. Swellling (1+ malleolus)
2. Tenseness
3. Tissue compromise
4. Deformities (dislocation of tibiotalar joint / gross displacement)

Question 10

What should you FEEL for in examination of an Ankle #? (2 things)

Answer 10

1. Bony tenderness (Ottowa Rules)
2. Pulses + sensation

Question 11

What MOVEMENTS should you assess in examination of an Ankle #? (4 things)

Answer 11

1. Inversion
2. Eversion
3. Plantar flexion
4. Dorsiflexion

Question 12

What rules indicate the need for ankle XR?

Answer 12

Ottowa Rules

Question 13

What are the Ottowa Rules? (3 things)

Answer 13

Pt needs ankle XR if has pain + one of:

1. Bony tenderness @ lat. malleolar tip to post. border of fibula
2. Bony tenderness @ med. malleolar tip to post. border of tibia
3. Inability to walk 4 weight bearing steps

Question 14

What imaging should be done for Ankle #s?

Answer 14

1. Plain XR (AP + lat)
2. CT for complex #

Question 15

What should you check for in XR of Ankle #s? (2 things)

Answer 15

1. Check joint space for uniformity
2. Ensure no evidence of talar shift

Question 16

What is the initial management of an Ankle #? (2 things)

Answer 16

1. Immediate # reduction (under sedation)
2. Place ankle in below knee back slab (aka cast)

Question 17

What are the indications for Conservative management of an Ankle #? (3 things)

Answer 17

1. Non-displaced medial malleolus #
2. Weber A/B # w/o talar shift
3. Unfit for surgery

Question 18

What are the indications for Surgical management of an Ankle #? (4 things)

Answer 18

1. Displaced bi/tri malleolar #
2. Weber B # w talar shift
3. Weber C #
4. Open #

Question 19

What is the Surgical management of Ankle #s?

Answer 19

Open Reduction & Internal Fixation (ORIF)

Question 20

What is the complication of Ankle #s?

Answer 20

Post-traumatic arthritis

Question 21

What are the complications of Open Reduction & Internal Fixation (ORIF)? (4 things)

Answer 21

1. Infection @ surgical site
2. DVT / PE
3. Non-union
4. Metalwork prominence