Ankle Fractures Flashcards
What is the ankle joint comprised of
Talus articulating with the mortise
What is the mortise
Tibial plafond
Medial malleolus
Lateral malleolus
What is the syndesmosis
strong fibrous structure comprised of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and the intra-osseous membrane.
What is a ankle fracture
a fracture of any malleolus (lateral, medial, or posterior), with or without disruption to the syndesmosis.
What are the two ways that ankle fractures can be classified in
Anatomically
Weber classification
What are the anatomical classification of ankle fractures
isolated lateral malleolar fractures, isolated medial malleolar fractures, bimalleolar fractures and trimalleolar fractures.
What is the Weber classification
It only classifies the lateral malleolus fractures
Type A - below the syndesmosis
Type B - at the level of syndesmosis
Type C - above the syndesmosis
What are the clinical features of patients with ankle fractures
Ankle pain
Associated deformity - if dislocated ( this will need urgent reduction)
Swelling
Tenderness
What are the Ottawa ankle rules and when are they used
When there is diagnostic uncertainty and help to decide whether a plain radiograph needs to be taken or not
They state:
- bone tenderness at posterior edge or tip of the lateral malleolus
- Bone tenderness at the posterior edge or tip of the medial malleolus
- inability to bear weight both immediately and in the emergency department for four steps
When can the Ottawa ankle rules be hard to follow
If pt is intoxicated, has other painful injuries, diminished sensation in the leg, gross swelling
What are the investigations that need to be carried out
Plain radiographs in AP and lateral views making sure to check the joint space and look for Talar shift
Complex fractures may require a CT scan for surgical planning
What is the initial management of ankle fractures
Immediate reduction if dislocated - usually done under sedation
Then place in below knee back slab
Carry out a neurovascular examination
Request Radiograph
When is conservative management used.
Non-displaced medial malleolus fractures
Weber A fractures or Weber B
fractures without talar shift
Those unfit for surgical intervention
What is the surgical management for ankle fractures
ORIF
When is surgical treatment used
Displaced bimalleolar or trimalleolar fractures
Weber C fractures
Weber B fractures with talar shift
Open fractures
