Ankle fractures Flashcards Preview

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Flashcards in Ankle fractures Deck (16):
1

What role does the deltoid ligament have?

Primary stabiliser to anterolateral talar displacement

2

What role does the fibula have?

Acts as a butress to prevent lateral displacement of the talus

3

What xrays and measurements are useful to assess the injured ankle?

AP and Lateral - WB f possible
EXTERNAL ROTATION STRESS - assess deltoid log- MEDIAL CLEAR SPACE >4MM= DELTOID DISRUPTION
TIBIOFIB OVERLAP normal >10MM
TIBIOFIB SPACE Normal <5MM
TALAR SUBLUXATION
TALAR TILT

4

Name some classifications systems of ankle fractures ?

AO- 44 A- INFRASYNDESMTOIC
44B - TRANSSYDESMOTIC
44C - SUPRASYNDESMOTIC
WEBER- A -NFRASYNDESMTOIC
B- TRANSSYDESMOTIC
C-SUPRASYNDESMOTIC
LAUGE- HANSEN

5

Describe the LAUGE- HANSEN classification in more detail

SUPINATION ADDUCTION- Distal to FIB avulsion, Vertical med mall fracture, Impaction of anteromed distal tibia
SUPINATION EXTERNAL ROTATION- ant tibiofib lig, lat oblique short fib (POST-INF to SUP-ANT), Post tib lig rupture/ Post mall fracture, Transverse med mall fracture= WEBER B
PRONATION ABDUCTION- med mall transv frac, ant tibfib lig sprain, transve comminuted fib frac= weber C
PRONATION EXT ROTATION- MED mall small AS TO POST-INF, Ant tibiofib lig, Lat oblique spiral fib frac, POst Mall/ post tibiofib lig

6

What is the criteria for non op tx?

non displaced Medial malleolus
<25% joint involved of POST mall

7

What is non op tx?

Short walking cast 4-6 weeks

8

What is the criteria for op tx?

Displaced >3mm Lat mall fracture
Displaced Medial mall fracture
Talar shift
Displaced bilateral mall fracture

9

What is the aim for op tx?

Stable anatomical reduction ti improve functional outcome
A 1mm shift of talus-> 42% reduction in tibiotalar contact area

10

In which pt is outcome worse ?

Smokers
Reduced education
Excess ETOH
Increased Age
Presence of medial mall fracture

11

What surgical methods could you use to fix fibular?

Lateral neutralisation plate and AP lag screw
Fibular nail
Postlat plate has greater stability but greater risk of soft tissue irritation- esp peroneal tendons

12

What surgical methods could you use to fix med mall ?

medial lag screws
TBW
medial buttress for vertical fracture

13

What methods could you use to fix post mall? Which approach would you use?

AP lag screw
Post butress plate
Posterior or posteriolateral - depends on fracture configuration and whether the fibula needs fixing.

14

What xray changes are suggestive of syndesmotic injury?

Increase in medial clear space
tibiofib clear space >5mm
tibiofib overlap reduces
Common with fibular fracture over 6mm from ankle joint

15

Briefly describe how you would fix a syndesmotic injury

restore fibular length and orientation
1-2 cortical screws (3.5mm women,4.5mm men)
2-4 cm above the joint angle post to ant

16

What is your post op regime post surgical fixation of syndesmotic injury?

Post op NWB 8-12 weeks
No ev to suggest ant diff between screw removal, loosening or breakage effects outcome at 1 year