Flashcards in Ankle fractures Deck (16):
What role does the deltoid ligament have?
Primary stabiliser to anterolateral talar displacement
What role does the fibula have?
Acts as a butress to prevent lateral displacement of the talus
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
Name some classifications systems of ankle fractures ?
AO- 44 A- INFRASYNDESMTOIC
44B - TRANSSYDESMOTIC
44C - SUPRASYNDESMOTIC
WEBER- A -NFRASYNDESMTOIC
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
What is the criteria for non op tx?
non displaced Medial malleolus
<25% joint involved of POST mall
What is non op tx?
Short walking cast 4-6 weeks
What is the criteria for op tx?
Displaced >3mm Lat mall fracture
Displaced Medial mall fracture
Displaced bilateral mall fracture
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
In which pt is outcome worse ?
Presence of medial mall fracture
What surgical methods could you use to fix fibular?
Lateral neutralisation plate and AP lag screw
Postlat plate has greater stability but greater risk of soft tissue irritation- esp peroneal tendons
What surgical methods could you use to fix med mall ?
medial lag screws
medial buttress for vertical fracture
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.
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
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