Ankle Fractures (Pod med) Flashcards by Zahra Lotfollahi

Remember these structures

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Remember these structurez

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The OTTAWA ankle rules:

If pain exist in A

PLUS one or more of the following:

A : near one or both of the malleoli

B: Age < 55 years old

C: Inability to weight bear

D: Bone tenderness over the the posterior edge or tip of either malleolus

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What is the normal space for Tib-Fib clear space on the mortise view?

less than 5 mm

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What is Mortise x-ray view?

With the A in B degrees of C rotation

Mortise view is useful in valuation of articular surface

between D and E

A: Ankle

B: 15-25 degrees

C: Internal rotation

D: Talar dome

E: Mortise

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Where is the Medial Clear space?

What is the normal value?

Medial clear space is between

Lateral border of medial malleous

and

Medial Talus

The normal value is less than 4 mm

And more than 4mm suggest lateral shift of talus

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Fibular fracture above the level of the ankle joint indicates

that the A is torn.

A: Distal anterior tibiofibular ligament

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Fracture of fibula above its anterior tubrcle strongly suggests that the B is completely distrupted.

B: Tibiofibular syndosmosis

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Fracture of fibula above the level of ankle joint WITHOUT accompaying fracture of the medial malleolus indicates rupture of A

A deltoid ligament

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A fracture of the medial malleolus indicates that the deltoid ligament is intact

A Transverse

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What is Maison neuve fracture?

High fracture of the fibula

fracture of the medial malleolous

Tear of tibiofibular ligament

Rupture of interoseous membrane

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What does the inversion stress view shows?

This angle helps to diagnose tears of lateral collateral ligament.

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The anterior-draw stress film provides a useful measurment for determining injury to the

A ligament

A : anterior talofibular ligament

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Values of upto A of seperation between the talus and distal tibia are considered normal

Values between B and C may be normal or abnormal and the opposite ankle should be tested

Values above D are always abnormal

A: 5mm

B: 5mm and C: 10mm

D: 10mm

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What are the primary goals for management of ankle fractures?

Restore function
Return to normal function

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What are different types of fractures?

Hint: 8 different

Spiral
Oblique
Transverse
Comminuted
Wedge
Impacted/Compression
Displaced
Open or compound

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Supination Adduction

It occurs in A% of ankle fractures

The foot is fixed on the ground in B position with an C force is applied to the talus

A: 20-25%

B: Supination C: Adduction

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Suppination Adduction

Stage 1

Supination results in a tear of the A ligament

An B fracture of the C below the level of tibial plafond

A: Lateral collateral ligament

B: avulsion

C: Lateral malleolus

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Supination Adduction

Stage 1

A rupture with or without B fragment and or C fracture of D malleoli below the ankle mortise

A: lateral ligament

B: Avulsion

C: transverse

D: lateral

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Supination Adduction

Stage 2

A fracture of the B malleoli

A: Vertical

B: Medial

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Supination Adduction

Stage 2

More talar tilt results in the medial malleolus being

pushed of in a A or B way

A: Vertical

B: Oblique

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What is the name of this fracture?

Supination Adduction

What does the grey arrow show?

What does the orange arrow show?

Grey arrow: Lateral injury, transverse fibular fracture below or at the level of mortise

Orange arrow: Medial injury, vertical shear type, medial malleolar fracture

Pronation- Abduction

It occurs very A

Stage 1: B medial C fracture

Or D ligament rupture

A: Rarely

B: Transverse C: Malleoli

D: Deltoid

**Pronation Abduction** Stage 2: As the abductory force continues to push the talus _A_ Creating injury to both _B_ and _C_ In this stage the _D_ is still intact

**Pronation Abduction** _A_: Laterally _B_: Anterior tibiofibular _C_: Posterior tibiofibular _D_: interossious ligament

**Pronation Abduction** Stage 3: In this stage the abductory force has continued into the fibula creating a fracture at _A_ that is _B_ on AP view But appears _C_ on a lateral view

**Pronation Abduction** _A_: at or above the ankle joint _B_: short and oblique _C_: transverse

**Pronation Abduction** Stage 3: _A_ fracture typically proximal to mortise often with a _B_ fragment The lateral view is important to differentiate it from _C_ fracture

**Pronation Abduction** _A:_ Fibula _B_: Butterfly _C_: Supination Eversion

**Supination External rotation** This is the _A_ common fracture In stage 1: Rupture of _B_ ligament Or a fracture of _C_, also known as _D_

**Supination External rotation** _A_: Most common _B_: Anterior tibiofibular ligament _C_: Lateral distal tibia _D_: Tillaux- Chaput fracture

**Supination External Rotation** Stage 2: Spiral fracture of _A_ at the _B_ level The most commonly encountered ankle fracture

**Supination External Rotation** _A_: Fibula _B_: Syndosmotic level

**Supination- External Rotation** Stage 3: As the force progresses it will involve either a rupture of _A_ Or the fracture of _B_ of the tibia Also known as the _C_ fracture

**Supination- External Rotation** _A_: Posterior tibiofibular ligament _B_: Posterior Malleolus of the tibia _C_: Volkman's fracture

**Supination External rotation** Stage 4: _A_ ligament tear or _B_ transverse fracture

_A_: Deltoid _B_: Medial Malleolus

**Supination- External Rotation** Hallmarks of this injury: Injury begining at the _A_ aspect of the fibula

_A_: Lateral

**Pronation External rotation** With the foot in a fixed pronated position, the force starts along the _A_ aspect of the tibia Stage 1: Rupture of _B_ ligament or transverse fracture of _C_

_A:_ Medial _B_: Deltoid _C_: Medial Malleolus

**Pronation external rotation** As the injury progresses forward to stage 2, the talus rotates further laterally putting tension on the _A_ ligament resulting in either rupture of this ligament or an avlusion fracture of _B_ Also known as _C_ fracture

_A_: Anterior inferior tibiofibular ligament _B_: anterior portion of fibula or tibia _C_: Volkman's fracture

**Pronation External rotation** As the force continue pass stage 2, Rupture of A memabrane begin to occur distally at the level of B

A: Intersous membrane B: Ankle joint

**Pronation External Rotation** Stage 3 fracture High _A_ fracture with _B_ This fracture can be at various levels of fibula

_A_: Fibular fracture _B_: Interosseus membrane

**Pronation External rotation** If the forces progress into stage 4 either a rupture of A or a fracture of B also know as C occurs True diastasis fracture

A: posterior tibiofibular B: Posterior malleoules C: Volkman fracture

Pronation External Rotation The main hallmark is the _A_

_A_: High fracture of the fibula

What stage and type of injury has occured? A. B.

A. Stage 4 B. Pronation External rotation because the fracture has occured proximally

Exam **Weber Classification** Weber A Weber B Weber C Concept!

A: Fibula distal to mortise B. Fibula at level of mortise C: Fibula proximal to mortise The higher the the fibula the more severe the injury

**Maionneure fracture:** Fracture of _A_ with _B_ disruption

_A_: Proximal fibula _B_: Syndesmotic disruption

**Volkman Fracture** Fracture of _A_ attachment of _B_ _C_ fracture type

_A_: tibial attachment _B_: PITFL _C_: Posterior Malleolar fracture

**Tillaux- Chaput fracture** Fracture of tibial attachment of _A_

A: AITFL

**Pott fracture** In Pott fracture, the fibual is fractured above _A_ The _B_ is ruptured The _C_ is laterally subluxed

_A_: the intact distal tibiofibular syndesmosis _B_: Deltoid _C_: Talus

**Dupuytern fracture** This fracture usually occurs _A_ above the _B_ With disruption of the _C_ ligament and Typically tear of the D leading to ankle instability

A: 2 to 7 cm B: dital tibiofibualr syndesmosis C: Medial collateral ligament D: syndosmosis

**Wagstaffe-Lefort fracture** In this fracture, the medial portion of the _A_ is avulsed at the insertion of the _B_ the _C_ however, remains intact

A: Fibula B: anterior tibiofibular ligament C: ligament

**Bosworth fracture dislocation** _A_ fracture with posterior dislocation of _B_ segment behind tibia

A: Fibular fracture B: Proximal fibular

The terms _A_, _B_, and _C_ all have been used to intraarticular fractures of the distal tibia.

A: tibial plafond fracture B: Pilon fracture C: Disal tibial explosion fracture

Classify this fracture

Supination abduction (external rotation) stage 4

Classify this fracture?

Pronation abduction stage 3

What are the 3 indications for non-operative short leg walking cast/boot? 1. 2. 3.

1. Isolated nondisplaced medial malleolus fracture or tip avulsions 2. Isolated lateral malleolus fracture with \< 3mm displacement and no talar shift 3. Posterior malleolus fracture with \< 25% joint involvment

EXAM What are the 7 indications for Operative open reduction internal fixation? 1. 2. 3. 4. 5. 6. 7.

1. Any talar displacement 2. Displaced isolated medial malleolar fracture 3. Displaced isolated lateral malleolar fracture 4. Bimalleolar fracture and bimalleolar equivalent fracture 5. Posterior malleolar fracture with \> 25% involvment 6. Bosworth fracture-dislocations 7. Open fractures 8.