ankle fractures Flashcards
The flat part of the distal tibia that articulates with the talus is called what
tibial plafont
This is a rectangular socket created by the medial malleolus, tibial plafont, and lateral malleolus
ankle mortise
Pneumonic for remembering the 4 syndesmotic ligaments?
“PAINT”
- Posterior Inferior Tibiofibular (PITFL)
- Anterior inferior Tibiofibular ligament (AITFL)
- Interosseous ligament
- inferior transverse ligament
How much tibia/fibula overlap should there be on x-ray
> 6 mm on AP
>1 mm on mortise
How much Tibia/Fibular clear space should there be on x-ray
- <6 mm on AP
- <6 mm on mortise
what is the medial clear space on ankle x-ray and what should it measure
- Space between medial malleolus and talus on mortise view
- should be < 4 mm
What is used to determine whether the fibula is shortened or at an appropriate length
Dime sign
Common ankle fracture classifications?
- Lauge Hansen
- Webber
Lauge Hansen ankle fractures are based on what
mechanism of injury
Most common Lauge Hansen ankle fracture
-Supination External Rotation (SER)
What are the 4 stages of Lauge Hansen SER fx
1) ATFL sprain
2) Distal fibula fx: - Spiral pattern, from anteroinferior, at the level of syndesmosis
3) PITFL rupture or Posterior malleolus fracture
4) Medial malleolus transverse fx or Deltoid ligament rupture
Stages of Lauge Hansen supination Adduction (SAD) injury
1) Talofibular ligament sprain or Distal fibula avulsion fx: below the plafond, transverse pattern
2) VERTICAL MEDIAL MALLEOLUS FX and impaction of anteriormedial distal tibia
Stages of Lauge Hansen Pronation ABduction (PA) Fx
1) Medial malleolus transverse fx or deltoid ligament rupture
2) ATFL sprain
3) Distal Fibula fracture: oblique/comminuted fibula fx, at or above the level of the syndesmosis
Stages of Lauge Hansen Pronation external rotation (PER) fx
1) Medal malleolus transverse fx or Deltoid ligament rupture
2) Anterior tibiofibular ligament disruption
3) Distal fibula fx: Spiral pattern, Anterosuperior to posteroinferior, above the level of the syndesmosis
4) Posterior tibiofibular ligament rupture or posterior malleolus fx
Describe the Danis-Weber ankle fx classification
- Based on the level of the fibular fx
- A: below level of tibial plafond
- B: at or near level of tibial plafond
- C: above level of the syndesmosis
Describe the correlation b/t Danis Weber and and Lauge Hansen classifications
- C: PER or PA
- B: SER
- A: SAd
Management of ankle fracture w/ dislocation in ER
- Hematoma block
- closed reduction and spling
- Even if they need surgery, reducing the disolocation will calm down tissues
Describe how to put hematoma block
- find tibialis anterior by having patient dorsiflex the great toe and go medial to the tendon
- Aim towards posterior aspect of lateral malleolus
proper splint for ankle fx
- AO splint
- Consists of “U” stirrup and posterior slab
what are the operative indications in an ankle fx? . .. basically what makes it unstable
- Bimalleolar fx
- Bimalleolar equivalent fx: medial clear space > 4 mm
- Trimalleolar fx
- Syndesmostic injury
- Posterior malleolar fx: >25% articular involvement or > 2 mm articular step off
- Displaced isolated lateral malleolar fx: >3 mm displacement
- Displaced isolated medial malleolar fx: any displacement or Talar shift > 1 mm
If you see an isolated lateral malleolus fx at or above the level of the syndesmosis, in order to make sure that you don’t have a medial malleolar equivalent or deltoid rupture what must you do?
must get an external rotation stress view
Describe the ORIF for lateral ankle fx
-Lag screw and 1/3 tubular plate
Describe the ORIF of the medial side malleolar fx
-partially threaded cancellous screw
How do you intraoperatively test for syndesmotic stability
- Cotton test or
- External rotation stress test
Plan for Syndesmotic injury operatively
-all plans different so could look this up
Ankle fx dislocation where fibula gets entrapped behind the posterolateral ridge of the tibia
Bosworth fx
what nerve will be in danger during the lateral approach to the ankle
superficial peroneal nerve
