Ankle Fractures Phong Tran Orthopaedic Surgeon Western Health
- Slides: 37
Ankle Fractures Phong Tran Orthopaedic Surgeon Western Health
Ankle fractures • • • Most common fracture treated by orthopaedic surgeon Low energy injuries Twisting mechanism (similar to ankle sprains) 2
History and Examination • Mechanism of Injury – high vs low • PMHx • • Diabetes, smoker, neuropathy Examination • Soft tissue • swelling, • blisters, • Bruising • Wounds • Special Tests • Areas of tenderness • Squeeze test • Ottawa 3
Maisonneuve Fracture 4
Ottawa Ankle Rules: Order ankle x-rays if acute trauma to ankle and one or more of • Age 55 or older • Inability to weight bear both immediately and in ER (4 steps) • Bony tenderness over posterior distal 6 cm of lateral or medial malleoli • Sensitivity ~100% • Specificity ~40% 5
Investigations AP Mortise Lateral 15° IR 6
Reading Xrays • Lateral malleolus • Medial malleolus • Syndesmosis • Mortice / Talar shift • Posterior malleolus 7
Reading Xrays • Lateral malleolus • Medial malleolus • Syndesmosis • Mortice / Talar shift • Posterior malleolus 8
Reading Xrays • Lateral malleolus • Medial malleolus • Syndesmosis • Mortice / Talar shift • Posterior malleolus 9
Mortise X-Ray • ankle in 15 -25° of IR
Mortise X-Ray • Medial clear space – Between lateral border of medial malleous and medial talus – <4 mm is normal – >4 mm suggests lateral shift of talus
Mortise X-Ray
Mortise x-ray:
Mortise x-ray:
Classification • Lauge-Hansen (1949) • Weber (1972) - AO 15
Lauge - Hansen classification • Mechanism of injury • • • Supination Adduction Supination External rotation Pronation Adduction Pronation External rotation Complicated / Hard to Remember 16
Supination External Rotation 17
Weber classification Advantages: • easy to use • provides information about fibular Disadvantages: • ignores the medial injury The AO classification system • Modification of the Weber system • subdivided on the basis medial or posterior injury 18
Weber classification 19
Weber classification 20
Weber classification 21
Management priorities 1. Reduce 2. • Provisional reduction • Care of open fracture • Soft tissues Hold 3. • Precise definitive reduction • Cast • ORIF Move • Rehabilitation 22
Goals of Treatment • Healed fracture • Ankle that moves and functions normally without pain 23
Cast vs Internal Fixation • • • What is broken? • Medial Malleolus • Lateral Malleolus • Posterior Malleolus • Syndesmosis Does it need to be reduced? Stable vs Unstable 24
Stable vs Unstable • The ankle is a ring – – – – Source: Rosen Tibial plafond Medial malleolus Deltoid ligaments calcaneous Lateral collateral ligaments Lateral malleolus Syndesmosis
Stable vs Unstable • Fracture 1 part = usually stable • Fracture > 1 part = unstable
Unstable fractures • Lateral talar shift • Bimalleolar • Lateral fractures + medial tenderness • Syndemosis Injuries • Maisonneuve 27
Unstable fractures • Lateral talar shift • Bimalleolar • Lateral fractures + medial tenderness • Syndemosis Injuries • Maisonneuve 28
Unstable fractures • Lateral talar shift • Bimalleolar • Lateral fractures + medial tenderness • Syndemosis Injuries • Maisonneuve 29
Lateral Shift of Talus 1 -mm lateral shift = decreased contact area by 42% 3 mm of lateral shift, = decreased contact area by 60% 30
Lateral Shift of Talus 31
Pilon / Plafond fractures 32
Pilon / Plafond fractures • Fracture of distal tibial metaphysis – Often comminuted – Often significant other injuries • Mechanism – Axial load – Position of foot determines injury • Treatment – Unstable – X-ray tib/fib & ankle – Orthopedic consultation 33
Tillaux Fracture • Occurs in 12 -14 year olds 18 month period when epiphysis is closing • Salter-Harris 3 injury Runs through anterolateral physis until reaches fused part, then extends inferiorly through epiphysis into joint Visible if x-ray parallel to plane of fracture (may require oblique) • Mechanism External rotation Strenth of tibiofibular ligament > unfused epiphysis 34
Tillaux Fracture • Occurs in 12 -14 year olds 18 month period when epiphysis is closing • Salter-Harris 3 injury • Mechanism External rotation Strenth of tibiofibular ligament > unfused epiphysis 35
Tillaux Fracture • Management Articular injury Gap >2 mm in articular surface = ORIF Non-displaced • NWB below knee cast Displaced • surgery 36
Thank you
- Phong tran surgeon
- Peter worlock orthopaedic surgeon
- Stephen brennan bon secours
- Danis and weber classification
- Orthopaedic treatment south east london
- Miss sally tennant
- Rch fracture guidelines
- Cappagh hospital day ward
- Vbpm orthopaedic
- Charcot's joints
- Professor abudu royal orthopaedic hospital
- Irving tennis elbow
- Radial fractures glass
- Radial lines glass
- Gustilo anderson classification antibiotics
- Fracture diacondylienne
- Fracture de malgaigne bassin
- What is water seal chest tube
- Bone cancer fractures
- Panfacial fractures sequencing
- Daniel tibia
- Dr sukhpal singh
- Open fracture treatment
- Types of fractures with pictures
- Types of fractures with pictures
- Tubular shaft of a long bone
- Ilioposas
- Triradiate cartilage x ray
- Types of glass fractures
- Non union types
- Bobine d'andrieu
- Hiện tượng phóng xạ
- Phong reflection model
- Gouraud shading implementation
- Lập đội thiếu niên tiền phong hồ chí minh
- Giai đoạn 1 phong trào cần vương
- Huy hiệu đội thiếu niên tiền phong hồ chí minh
- Sông hương là một bức tranh phong cảnh khổ dài