Lower leg fractures

Question 1

What is a tibial fracture?

Answer 1

Most common fracture

Open fractures common due to SC position

Must ensure both knee and ankle is imaged

Question 2

What is the management of a tibial fracture?

Answer 2

Minimally/undisplaced them full length cast

Displaced= reduction under GA with XR guidance and then cast

Limb elevated for 48hrs to look for compartment syndrome

Repeat XR 2wks later to check position

At 4wks cast changed to below knee to allow weight bearing

Question 3

What are ankle fractures?

Answer 3

Common injury in young athletes or older osteoporotic women

3 malleoli can be fractured

• medial
• lateral
• posterior (formed by posterior tibia)

Most common mechanism is abduction and lateral rotation of joint causing lateral malleolus to be sheared off

Question 4

What is found on examination for a patient with ankle fracture?

Answer 4

Intense pain and inability to stand

Question 5

What is weber Classification?

Answer 5

Used to classify lateral malleolus fractures based on tibifibular joint (syndesmosis)

A- fracture below syndesmosis

B- fracture at level of syndesmosis

C- fracture above syndesmosis

Question 6

What is talar shift?

Answer 6

Important indicator of instability in the ankle

If talus no long exhibits equal joint space around its articulation with tibia and fibula then likely to need surgery

Question 7

What is the management of ankle fractures?

Answer 7

Weber A
-6 weeks of plaster normally works

Weber B
-Conservative management with repeat XR at wks 1, 2 and sometimes 3

Weber C

• Never stable
• requires open reduction and internal fixation

If >1 malleoli is unstable= surgery

Question 8

What is ottowa rules for ankle fractures?

Answer 8

XR of ankle is only required if patient is unable to weight bare, has pain and bony tenderness over lateral or medial malleolus

XR of foot is only if unable to weight bare and bony tenderness over navicular/base of 5th metatarsal