Ankle Fracture

Question 1

Questions to ask for ankle injury

Answer 1

• Onset
• Location of pain
• Activity at the time
• Weight bearing?
• ROM
• Previous ankle injuries/problems

Question 2

Examination things to look for for ankle #

Answer 2

• Deformity - higher risk of NV compromise
• Open # - needs debridement and irrigation
• Check Ottawa rules if unsure

Question 3

What are the Ottawa rules for ankle pain?

Answer 3

Apply if uncertain - eg if patient can mobilise and has no deformity.
X-rays should be taken if any of following apply:
* Bone tenderness at posterior edge or tip of lateral malleolus OR
* Bone tenderness at posterior edge or tip of medial malleolus OR
* Inability to weight bear immediately and in emergency department for 4 steps

Question 4

Investigations for suspected ankle #

Answer 4

• X-ray - AP lateral and mortise view. Ankle needs to be fully dorsiflexed
• CT if complex or posterior malleolus displaced

DorSI to SEE

Question 5

Emergency treatment for ankle # in ED

Answer 5

• Immediate reduction of fracture under sedation
• Allows realignment
• Stabilise with below knee back slab
• Document post reduction NV status of limb

Question 6

How do you check if reduction was adequate?

Answer 6

• Repeat x-ray, if inadequate realignment, repeat

Question 7

When would patient have surgery for fracture of ankle?

Answer 7

• Displaced bimalleolar or trimalleolar fracture
• Weber class C
• Weber class B with talar shift
• Open fractures

Question 8

Classification of ankle fractures

Answer 8

• Weber classification - if lateral malleolus
• Lauge Hansen classification - based on ankle position at time of injury, deforming force, much more detailed than Weber

Helly Hansen sounds like wellies - go over ankle

Question 9

Weber classifcation of fractures

Answer 9

Class A, B and C
More proximal = higher risk of instability
= C often surgically fixation managed

Question 10

Walking aids given for patient following internal fixation of ankle joint

Answer 10

• Under arm crutches
• Zimmer frame
• Orthopedic boot
• Knee scooter
• Wheelchair
• Assistance for home eg handrails etc

Question 11

How long before can work and do sport post internal fixation of ankle?

Answer 11

• Work - depends on job
• Sport - 6 weeks of boot, then gradual physio out of boot, standard time is 12 weeks post surgery

Question 12

When is conservative management used in ankle #? (post reduction)

Answer 12

• Non-displaced medial malleolus #
• Weber A (all) or Weber B fractures without talar shift
• Those unfit for surgical intervention

Question 13

Complications post ankle #

Answer 13

• Post traumatic arthirtis - rare with adequate treatment of reduction and fixation

Question 14

Anatomical classification of ankle #

Answer 14

• Lateral malleolus
• Medial malleolus
• Bimalleolar
• Trimalleolar

Question 15

What keeps ankle joint stable usually?

Answer 15

• Interosseus membrane between tibia and fibula
• Anterior inferior tibiofibular ligament
• Posterior inferior tibiofibular ligament

PITFL - pitfall

Question 16

Normal ankle anatomy

Answer 16