Dr Beaver's tute - fractures of the ankle

Question 1

the weber classification

Answer 1

based on syndesmosis joint of tibia and fibula
A - distal to the syndesmosis at the lateral malleolus (stops talus from falling laterally)
B - at the level of the syndesmosis
C - proximal to the syndesmosis

Question 2

what is a syndesmosis

Answer 2

fibrous joint held together by strong ligaments
moves a little bit but not a lot

Question 3

what is the significance of the weber classification

Answer 3

changes choice of treatment
A - treat with plaster
C - operate and repair the syndesmosis - if the syndesmosis is interrupted
B - could go either way but in most places they would elect for plating

Question 4

if the fracture doesn’t involve the syndesmosis

Answer 4

treat with plaster it’ll be fine

Question 5

how do you heal the syndesmosis

Answer 5

screw through the fibula and tibia until it heals then take the screw out
they can’t walk on it

Question 6

what views do you need for the ankle

Answer 6

3 view plain ankle x-ray:
AP, lateral and mortise (oblique, allows for evaluation of the distal tibiofibular syndesmosis, talus and joint spaces)
tibia fibila x-ray: AP and lateral views to evaluate for pilon or maisonneuve fracture

Question 7

Weber A fractures

Answer 7

lateral malleolar fracture below the syndesmosis
possible medial malleolar fracture
intact syndesmosis
usually stable

Question 8

weber B

Answer 8

fibiluar fracture at the level of the syndesmosis
possible syndesmotic injury and/or dletoid ligament injury
variable stability

Question 9

weber C fracture

Answer 9

fibular fracture above the syndesmosis
ruptured syndesmosis, torn intraosseous membrane
possible medial malleolar fracture and/or deltoid ligament tear
unstable

Question 10

maisonneuve fracture

Answer 10

considered weber C fractures
torn intraosseous membrane
ruptures synesmosis
possible medial malleolar fracture
unstable

Question 11

clinical evaluation

Answer 11

neurovascular exam
- assess dorsalis pedis and posterior tibial artery pulses and distal capillary refil time
- emamine motor and sensory function of the lower leg
skin exam: aevluate for laceration, tearing and tenting
associated injuries: examine the foot and knee
examine the entire length of the fibula in patient with ankle pin to evaluate for a miasoneuve fracture

Question 12

treatment initial appraoch

Answer 12

most ankle fractures are non weight bearing, except for isolated weber A fractures which can be weight bearing as tolerated
emergency fracture reduction if there is gross deformity with skin tenting or neurovascular compromise
administer IV antibiotics for open fractures without delay
stable, isolated nondisplaced fractures can be intitially mnged with immobilzation and ortho follow up within 48 hours

Question 13

definitive management for stable, closed isolated malleolar fractures

Answer 13

short leg cast or walking boot for 4-6 weeks

Question 14

definitive management for unstable fractures

Answer 14

for unstable or open fractues
open reduction and internal fixation or external fixation