T&O: Ankle Fractures Flashcards
What classification system is used in ankle fractures?
Weber classification: based on the fibular fracture in relation to the tibiofibular syndesmosis.
Type A, B and C.
Describe the features and management of a Weber A fracture.
Features:
- fibular fracture distal to tibiofibular syndesmosis
- syndesmosis intact
- deltoid ligament intact
- medial malleolus occasionally fractured
Management:
- usually stable
- can often be managed conservatively, e.g. POP cast.
- sometimes requires open reduction and internal fixation, esp. if medial malleolus fractured
Describe the features and management of a Weber B fracture.
Features:
- fibular fracture level to syndesmosis, or only partially torn
- deltoid ligament may be torn
- medial malleolus may be fractured
Management:
- variable stability
- likely requires ORIF
Describe the features and management of a Weber C fracture.
Features:
- fibular fracture proximal to syndesmosis
- tibiofibular syndesmosis disrupted, with widening of distal tibiofibular articulation
- medial malleolus fracture or deltoid ligament injury present
Management:
- unstable
- requires ORIF
What is a trimalleolar fracture?
Fracture of:
- lateral malleolus
- medial malleolus
- posterior corner of tibia
What is a Maisonneuve fracture?
Combination of:
- spiral fracture off proximal fibula
- unstable ankle injury - can manifest radiologically by:
- widening of ankle joint due to distal tibiofibular syndesmosis and/or fdeltoid ligament disruption OR
- fracture of medial malleolus
Is caused by pronation external-rotation mechanism.
Should Pts with stable Weber A fractures be allowed to weight bear? Why?
Yes. The fracture is stable as the intact deltoid ligament maintains the position of the talo-tibial joint. Weight bearing actually improves healing of the fibular fracture.
How can an ankle fracture be identified as stable on x-ray?
Look at medial side of joint: when undisplaced there is a medial clear space of <5 mm. Displaced/unstable if >5 mm.
How many ankle fractures are stable? How would you manage these?
70%
No active treatment necessary
- RICE
- ankle brace
- full weight-bearing
- active exercise
- no check x-rays