Ankle fractures. Sprains. Flashcards
what is the classification of ankle fractures ?
LAUGE HANSEN CLASSIFICATION - based on foot position and force of applied stress
SUPINATED (lateral ankles leaning outward > ) AND ADDUCTED ( toes lifted)
movement of the talus medially
2) sagital fracture of the medial malleolus of the tibia
with anteromedial impaction on the tibia
transverse fracture of the distal fibula
1) talofibular ligament sprain
SUPINATION AND EXTERNAL ROTATION
this injury has 4 stages
type 1 - anterior tibiofibular lig sprain
type 2 - + oblique fibular fracture going anterior inferior to posterioir superior
type 3 - + posterior tibiofibular ligament rupture
or avulsion of posterior malleolus
type 4 - + middle maleolus transverse fracture or disruption of the deltoid ligament connecting the medial inferior part of the tibia to the talus beneath
PRONATION (lateral ankled leaning inwards) AND external rotation
occurs in 4 stages
1) middle malleolus transverse fracture or disruption of deltoid ligament
2) anterior tibifibular ligament disruption
3) oblique fracture going anterosuperioirly to posteroinferioirly
4) posterioir tibiofibular lig avulsion of posterior malleolus
pronation (lateral ankles facing inward) and abduction (lateral toes lifted )
1) medial malleolus transverse fracture or disruption of deltoid ligament
2 ) anterior tibulofibular ligament sprain
3) transverse comminuted fracture of the fibula
what is the treatment of ankle fracture ?
non operative
ISOLATED non displaced medial malleolus fracture
ISOLATED lateral malleolus fracture with less than 3mm displacement
operative
open reduction of the talus to the anatomical position with the tibia
reduction and fixation of the fibular fracture first - compression plating with lag screw fixation - oblique fracture
if comminuted - bridge plating
the medial malleolar fracture - reduced with cancellous partially threaded lag screws
if vertical - antiglide plating/buttress plating where the screws are fixed distally to the fracture line
posterior malleolus fracture - lag screws applied
after fixation of everything see i there is any syndesmosis injury
identify if there is and tibiofibular ligament problems by external rotation stress view in the operating room check for medial clearing space - the distance between the medial malleolus and the medial part and proximal medial part of talus
widening of toibofibular clear space
reduce the syndesmosis and place feet in dorsiflexion place one or two cortical screws above the joint
what is the complication of ankle fractures?
postoperative stiffness
malunion esp in impaction of the anteromedial tibia
post traumatic arthritis
peripheral neuropathy - tarsal tunnel syndrome
