- rupture of lateral collateral - transverse fracture of fibula below AJ

- Rupture of the deltoid - Transverse fracture of medial malleolus

Ankle Fractures Flashcards by Michael Wolfe

Lauge-Hansen classification for ankles fractures is based on what 2 things?

Position of the foot

Motion of the talus

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4 main patterns of the Lauge-Hansen classification

Supination-AD
Pronation-AB
Supination-External
Pronation-External
-SAD, PAB, SER, PER

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SAD stage 1

rupture of lateral collateral

- transverse fracture of fibula below AJ

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SAD stage 2

Vertical fracture of the medial malleolus

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Vertical fracture of the medial malleolus is pathognomonic for what type of fracture

Supination-ADduction ankle fracture

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PAB stage 1

Rupture of the deltoid

- Transverse fracture of medial malleolus

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PAB stage 2

Disruption of the AITFL and PITFL

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PAB stage 3

Short oblique fracture of the fibula at the AJ

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Explain the stages (4) of SER

1 - disruption of AITFL
2 - spiral fracture of the fibula
3 - Disruption of PITFL
4 - rupture of deltoid or transverse fracture of Med Mal

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What is pathognomonic for supination-external rotation fracture?

Spiral fracture of the fibula at the AJ

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Explain the stages (4) of PER ankle fractures

1- deltoid or transverse MM
2- AITFL or interosseous
3- Fibular fracture proximal to syndesmosis
4- Disruption of PITFL

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What is pathognomonic for a pronation-external rotation ankle fracture?

High fibular fracture that is proximal to the syndesmosis

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Explain where the fractures/issues with SAD/PAB/SER/PER begin, respectively

SAD - laterally
PAB - Medially
SER - Anteriorly
PER - Medially

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The Danis-Weber classification of ankle fractures has how many main patterns? and is based on what relationship?

3 main patterns

Based on the fibula fracture and its relationship to the ankle joint

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Danis-Weber A fx location

Fibular fracture below the level of the ankle

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Danis-Weber B fx location

Fibular fracture at the level of the ankle

Danis-Weber C fx location

Fibular fracture above the level of the ankle

Danis-Weber A is equal to what Lauge Hansen?

Supination-Adduction

Danis-Weber B is equal to what Lauge Hansen?

Supination-external rotation OR Pronation-abduction

Danis-Weber C is equal to what Lauge Hansen?

Pronation-external rotation

Medial clear space - what is it

Space between lateral aspect of medial malleolus and the medial aspect of the talar body

> 3-5 mm represents a deltoid tear

Tibio-Fibular Overlap

Evaluate the syndesmosis

> 10 mm is normal

Talar Tilt

Evaluates the lateral ligaments

> 15 degrees is a tear

Tibio-Fibular Clear Space

Evaluates the syndesmosis and lateral talar shift

<5 mm is normal

Avulsion fracture fixation options

Tension band wire Cross K wires Lag Screws that are partially threaded cancellous

Vertical Medial Malleoulus fracture fixation options

Lag Screw using 2-3 partially threaded cancellous screws

Spiral fracture fixation options

Interfragmentary compression screws - perpendicular to bone - perpendicular to fracture line Plate

Difference b/w Lag by Technique and Design

Technique --> cortical screw, guide hole, glide hole Design --> cancellous screw, guide hole

What does cancellous not need a glide hole?

Because it has a smoother portion to glide in

Explain using a plate for a spiral fibular fracture

Neutralization plate - 1/3 tubular - cortical screws proximal - cancellous screws distal

When inserting a cortical/cancellous screw through a plate, do you need to drill a guide hole, glide hole, or both?

Only a GUIDE hole

Oblique Fibula or High Fibula fixation options

Need to use a plate b/c the fracture is too short to insert a interfragmentary screw

When do you fixate a posterior malleolus fracture?

When it doesn't reduce via Vassal's When it's greater than 25% of the joint surface

Explain the direct fixation for posterior malleolus fractures

Partially threaded cannulated screw directed P to A

Explain the indirect fixation for posterior malleolus fractures

Partially threaded cannulated screw direct A to P

Explain the technique for using a Syndesmotic screw

Insert screw proximal to the ankle, angle it anterior, dorsiflex the foot

How do you use a cortical screw for syndesmotic repair

No lag technique | Engage all four cortices

How do you use a cancellous screw for syndesmotic repair

Fully threaded and engage only 3 cortices

Prior to WB, what do you do with the syndesmotic screw?

REMOVE