Chapter 42- ankle injuries Flashcards
What are the three components making up the lateral ligament complex of the ankle?
- Anterior talo-fibular
- Calcaneo-fibular
- Posterior talo-fibular
Describe a Weber A fracture
- Inversion adduction
- Medial malleolus has an oblique fracture line
- lateral malleolus may be fractured below the syndesmosis or the lateral ligament is injured
- Syndesmosis is intact
- Talus displaces medially
Describe a Weber B fracture
- Eversion; abduction; external rotation
- Fracture at the level of the syndesmosis which may be partially ruptured
- talus dispalces laterally
Describe a Weber C fracture
- Abduction, external rotation
- The fibular fracture is anywhere above the syndesmosis which is torn
- Talus displaces laterally
- Medial (deltoid) ligament) is only injured in combination with a push-off fracture of the lateral side of the ankle (Weber B or C)
Describe a plafond fracture
- Vertical compression causes fracture of the distal tibia extending into the ankle joint
- Usually due to a fall from a height, forcing the talus upwards into the tibia
- It is an intra-articular fracture
Recurrent episodes of instability of the ankle joint are common following which injury?
Lateral ligament injury
Findings on examination of an ankle injury
- Swelling
- Bruising
- Deformity if displacement or dislocation present
- Tender ++
- ?Crepitus if fracture present
- Feel whole length of fibula for tenderness or crepitus
What should the position of the foot be in an AP X-ray of the foot
Foot should be 15 degrees internally rotated
In children- ligament injury is rare, therefore, what diagnosis is more likely for an unstable joint?
-Epiphyseal injury
What ‘masqueraders’ should be excluded in suspected ankle injury
Ruptured Achilles or posterior tibial tendon and fractures of the hindfoot bones
Treatment of an acute mild/moderate tear of ankle ligaments
- Eversion strapping or lateral stabilizing ankle brace for 3/52- use extension plaster only for the longitudinal part of eversion strapping
- Active ankle exercises
Treatment of an acute severe tear of ankle ligaments
- Below knee POP with ankle at right ankles and walking heel for 4/52 then
- Eversion strapping or ankle brace (air cast) 4/52
- Muscle strenghtening and physiotherapy
- Operative repair followed by POP for 6/52 may be done (rarely indicated)
Treatment of chronic injury to the ligaments of the ankle
- Physiotherapy ++
- Brace
- Refer to specialist
What are the criteria for an acceptable position of maleolar fractures
- Tibio-talar congruity: Displacement <2mm
- Lateral maleolus: No lateral or posterior shift although talar shift of <2mm may be tolerated by the ankle. Fibular length may be restored
- Syndesmosis diastases: <2mm
- Posterior maleolar fracture of <20 % of the articular surface can be ignored
- Medial mallelous: displacement is seldom important unless it reflects tibio-talar incongruity
Displacement beyond this–> reduction (closed or ORIF)
What cast is required in weber B and C to maintain reduction?
An above knee cast with 30 degrees knee flexion is needed to control rotation
