Ankle Fractures

Question 1

What are the generic types of ankle fractures ?

Answer 1

Lateral malleolar, medial malleolar, and posterior malleolar.

Question 2

What is a trimaleollar fracture?

Answer 2

It involves all the three malleoli and requires a CT scan for further diagnosis.

Question 3

What is the utility of a stress view X-ray in an ankle fracture?

Answer 3

It can help to differentiate supination/ external rotation type 02 fracture from supination/ external rotation type 04.

Question 4

What is the management of the deltoid ligament injury?

Answer 4

Non surgical conservative management.

Question 5

What is the structure that determines the stability of an ankle fracture?

Answer 5

It is the integrity of the deep deltoid ligament. If the deep deltoid ligament remains attached to the tibia the tallus will not be displaced in the ankle mortis.

Question 6

What type of fracture causes lateral shift of talus ?

Answer 6

It can happen in medial malleolar fracture or deep deltoid ligament injury that can detach deep deltoid ligament from the tibia.

Question 7

What is supination- external rotation type 02 fracture of the ankle and it’s management?

Answer 7

It is an undisplaced lateral malleolar fracture without medial injury, which requires only an ankle brace and WBAT.

Question 8

What is the indication for deep deltoid ligament injury in stress view of ankle?

Answer 8

An increased or widened medial clear space.

Question 9

What is the metric for tallar congruence on ankle mortis?

Answer 9

The medial clear space on the ankle image should be< 4mm or 2mm more than the superior clear space. Anything more than indicates tallar lateral shift and an unstable ankle joint.

Question 10

What are severe and unstable fibular fractures ?

Answer 10

Danny Webber type 3 fractures, especially if they are more than 4.5 cm above the plafond and if there is deep deltoid ligament injury. Then they require syndesmotic screw fixation.

Question 11

What are the three types of medial malleolar fractures that require surgical fixation?

Answer 11

1) anterior collecular fracture.
2) the typical medial malleolar fracture
3) vertical fracture of the medial malleolus

Question 12

What is the method for the fixation of anterior collecular fracture of the medial malleolus?

Answer 12

A tension band wire fixation.

Question 13

What is the fixation method for typical medial malleolar fracture?

Answer 13

Two bicortical lag screw fixation.

Question 14

What is Maisonneuve fracture?

Answer 14

It is the fracture of the proximal fibula with ankle instability due to syndesmotic widening. Therefore, syndesmotic screws will be required to stabilize it.

Question 15

What is Dennis Webber type A or the supination - adduction injury on Lauge- Hannson classification?

Answer 15

It is an ankle supination and adduction fracture of the fibula below the level of the fibular syndesmosis and tibial plafond. ORIF only be done, if there are dislodged bone fragments or joint instability. A cast or walker boot is used with RICE and WBAT.

Question 16

What is Danny- Webber type B or Supination- external rotation fracture in Lauge- Hannson classification?

Answer 16

It is an oblique or spiral fracture of the fibula at the level of the syndesmosis due to external rotation. There maybe associated injury to the medial structures and posterior malleolus. It accounts for 50% of syndesmotic fractures. It is treated with ORIF and syndesmotic screws.

Question 17

What is Danny- Webber type C or abduction- external rotation injury in Lauge-Hannson classification?

Answer 17

It is an abduction fracture of the fibula above the level of the syndesmosis. This is associated with medial injury in all cases. It requires surgical restoration of fibular length, syndesmotic screw.

Question 18

What is a pillon fracture?

Answer 18

It is a comminuted fracture of the tibial plafond due to axial high energy trauma causing impaction of tallus in to the tibia. It requires ORIF.

Question 19

What is a navicular stress fracture?

Answer 19

It occurs on the central third of the navicular bone, usually seen in baseball players and has an increased risk of avascular necrosis and malunion.
The patient will present with midfoot pain and edema. CT or MRI is needed to visualize the fracture as the X-ray maybe normal. The tx is cast and non weight bearing. ORIF in athletes

Question 20

What is the tx of the zone 1 of the base of the 5th Metatarsal fracture?

Answer 20

Use ankle boot or fracture shoes.

Question 21

What is the management of Jones fracture?

Answer 21

It is the zone 2 of the base of the 5th Metatarsal fracture at the junction of the metaphysis and diaphysis at the watershed area and has a risk of non union. The tx is non weight bearing if not displaced and screw fixation if displaced.

Question 22

What are the Hawkins classification of tallus fractures ?

Answer 22

Type 01- non displaced fracture with 10 % AVN.
Type-02: It is subtalar fracture with dislocation and 50% AVN.
Tyep-03: It is subtalar fracture with tibiotallar dislocation with 90% of AVN.
Type 04: it is a combination of talonavicular and tibiotallar dislocation with 100% AVN.

Question 23

What is Hawkins sign in tallus fracture?

Answer 23

It is subcondylar lucency seen 6 week post operative, if there is no Hawkins sign it means AVN.

Question 24

What is the most commonly injured ankle ligament?

Answer 24

The anterior tallofibular ligament due to plantar flexion and inversion and anterior drawer test will be positive.

Question 25

How to rule out calcaniofubular ligament injury?

Answer 25

It is caused by dorsi flexion and inversion and tallar tilt test will be positive.

Question 26

What is Lisfranc fracture?

Answer 26

It is the disruption of the Lisfranc ligament which articulates the medial cuneiform and the base of the second Metatarsal at the plantar aspect of the foot.