Ankle Fractures

Question 1

Should syndesmosis screws be removed?

Answer 1

Tucker et. al. (Injury 2013) suggest no… the retention of screw does not significantly impair functional capacity, and screw removal is not cost effective.

only remove if symptomatic beyond 6 months post-op

Question 2

What are known risk factors for wound complications following ankle fracture surgery?

Answer 2

• diabetes
• peripheral neuropathy
• wound-compromising medications
• open fractures
• post-operative non-compliance

Question 3

What is the 10 year outcome after ankle fracture ORIF?

Answer 3

Egol et. al.

• radiographic OA in 63%
• few with pain or functional restrictions
• outcomes comparable

Question 4

Malreduction of the syndesmosis according to Lorich study:

Answer 4

• malreduction occurred in 25% of their cohort
• most were anteriorly displaced within the incisura
• xrays are not good for diagnosing syndesmotic malreduction
• 83% were diagnosed on CT

Question 5

Do positive stress xrays necessitate surgery in isolated fibular fractures

Answer 5

Egol et. al. - no, high rate of positive stress radiographs for patients presenting with isolated fibular fractures and intact ankle mortise

Question 6

Normal Talocrural Angle

Answer 6

~80 degrees

• on mortise view
• assesses restoration of fibular length

Question 7

medial clear space should be:

Answer 7

4mm or less

Question 8

normal tibiofibular clear space

Answer 8

<6mm

Question 9

utility of CT in ankle fractures?

Answer 9

• posterior malleolar fractures
• talar/subtalar evaluation
• ankle instability (chronic) eval

Question 10

supination ADDUCTION injury is:

Answer 10

I: transverse fibula OR talofibular ligament rupture

II: I + a vertical medial malleolus, medial plafond impaction

***the vertical medial mal is the sine qua non of this injury

Question 11

Pronation ABDUCTION injury is:

Answer 11

• short avulsion-type medial malleolus

- transverse weber C fibula

Question 12

Pronation External ROtation injury is:

Answer 12

• transverse medial mall OR direct deltoid ligament rupture
• AITFL injury
• ## fibular fracture - above hte level of the syndesmosis, spiral in nature

Question 13

what contributes more to lateral ankle stability? medial mall or fibula?

Answer 13

fibula and its syndesmotic attachments

• fixing the medial malleolus alone causes insufficient talar reduction

Question 14

when the MMOLC is damaged, what happens to the talus?

Answer 14

if the fibula is also fractured, then you have instability.

Question 15

is there correlation between medial tenderness and deltoid ligament incompetence?

Answer 15

no. medial tenderness has 57% sensitivity and 60% specificity for dientifying a deepd eltoid injury

Question 16

infection rate in patients with DM and operatively treated ankle fractures?

Answer 16

as high as 60%

Question 17

the clinical and functional outcomes of operatively treated unstable ankle fractures int he general population?

Answer 17

up to 90% excellent results

Question 18

When do patients return to baseline braking function after ankle ORIF?

Answer 18

at 9 weeks post-op