2.7 Ankle Fractures Flashcards
What are some important landmarks in the ankle joint anatomy?
fibula, syndesmosis, tibia, talus Lateral malleolus (fibula), the mortice, medial malleolus (tibia), posterior malleolus (tibia).
What is the most common site of ankle fracture?
The lateral malleolus (fibula)
How is the name of the classification system for lateral malleoli fractures?
Weber classification
What are the different Weber classifications?
All relate to the syndesmosis (between fibula and tibia)
Weber A - fracture below the level of the syndesmosis (stable)
Weber B - fracture at the level of the syndesmosis (sometimes stable)
Weber C - fracture above the level of the syndesmosis (never stable)
This is Webers for lateral malleolus (fibula) fractures.
Management of lateral malleolus fractures for each classification?
Depends on stability and displacement.
Weber A is rarely surgical and is below knee complete plaster with weight bearing as pain allows.
Weber C is always unstable and need ORIF unless patient is not fit for surgery in which case plaster and non-weightbearing for 6-8 weeks.
Weber B is difficult decision. Sometime stable, sometimes not. Undisplaced or manipulated into good position then trial of conservative management. Check xrays at weeks 1 and 2 if displaced then ORIF, if not then continue non-weight bearing for 6-8weeks.
How are bi- and tri- malleolar fractures managed?
Usually will involve the lateral malleolus and will be unstable. (Managed the same as a Weber C) - ORIF
What is talar shift and what does it show?
When there is not equal space along the whole of the mortice.
This suggests there is an unstable fracture.
What does ‘pilon’ mean in French?
How is that related to pilon fractures? Mechanism?
‘pestle and mortar’ for pounding food
Fall from height landing on the feet, axial loading hammers the talus into the tibia and shatters it.
(can be low energy in skiers)
A quarter will be open fractures and there is a high risk of compartment syndrome.
Management of pilon fractures?
Low energy - prompt ORIF once swelling is acceptable. Care to reduce the intra-articular component accurately.
High energy is a problem - lots of soft tissue damage so lots of swelling. Struggle to suture close swollen soft tissue.. If compartment syndrome develops this needs emergency decompression. Open fracture needs washing and debriding.
For these reason early fixing is not possible. Should stabilise with external fixation, this buys time, allows elevation of leg. Once swelling has reduced the ORIF.
What has happened in a wedge fracture of the thoracolumbar spine?
How do you classify the stability?
Anterior part of body collapses leaving posterior part intact.
Often fragility fracture in elderly.
Denis classification for spinal fractures. Divide spine into 3 columns, if only one column is fracture then is it considered to be stable.
(posterior complex, middle component, anterior column)
History and exam finding in fragility fractures of the thoracolumbar spine (aka wedge fracture)?
Investigations?
- elderly patient fallen from standing height
- acute onset low back pain
- pain well localised and limits movement
- neuro exam should be normal, some radicular pain over dermatome
X-ray is best but:
- hard to tell if its old or new fracture
- hard to tell osteoporotic vs metastasis
CT can be used to:
- help grade stability (Denis)
- retropulsion of fragments into spinal cord
MRI for:
- more info about soft tissues
- especially if there are neurological features
Management of a wedge fracture?
- traditionally its conservative
- early mobilisation and analgesia help this succeed
- some evidence for thoracolumbar support braces
KYPHOPLASTY has become a more recent option
- percutaneous injection of cement
- GA or local anaesthetic
- stabilises anterior column = pain relief and quicker return to function.
C-spine injury can happen in all age groups. What imaging would you use?
- traditionally plain xray but this isn’t very useful
- AP and a lateral, may need “swimmers view” in short necks
- “peg view” take through the open mouth
TRAUMA:
- CT is initial imaging
- from vertex to symphsis
- if neuro involvement then also MRI
