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1

Remember these structures

2

Remember these structurez

3

The OTTAWA ankle rules:

If pain exist in A

PLUS one or more of the following:

B

C

D

 

 

A : near one or both of the malleoli 

 

B: Age < 55 years old

C: Inability to weight bear

D: Bone tenderness over the the posterior edge or tip of either malleolus 

4

What is the normal space for Tib-Fib clear space on the mortise view?

less than 5 mm

5

What is Mortise x-ray view?

With the A in B degrees of C rotation 

 

 

 

Mortise view is useful in valuation of articular surface

between D and E 

 

A: Ankle

B: 15-25 degrees

C: Internal rotation 

 

 

D: Talar dome

E: Mortise 

6

Where is the Medial Clear space?

What is the normal value?

 

Medial clear space is between 

Lateral border of medial malleous 

and 

Medial Talus 

The normal value is less than 4 mm

And more than 4mm suggest lateral shift of talus

7

Fibular fracture above the level of the ankle joint indicates

that the A is torn.

 

 

 

A: Distal anterior tibiofibular ligament

 

 

 

8

Fracture of fibula above its anterior tubrcle strongly suggests that the B is completely distrupted. 

 ​B: Tibiofibular syndosmosis

9

Fracture of fibula above the level of ankle joint WITHOUT accompaying fracture of the medial malleolus indicates rupture of A 

A deltoid ligament

10

A fracture of the medial malleolus indicates that the deltoid ligament is intact 

A Transverse 

 

11

What is Maison neuve fracture?

High fracture of the fibula 

fracture of the medial malleolous

Tear of tibiofibular ligament 

Rupture of interoseous membrane 

 

12

What does the inversion stress view shows?

This angle helps to diagnose tears of lateral collateral ligament. 

13

The anterior-draw stress film provides a useful measurment for determining injury to the 

A ligament

 

A : anterior talofibular ligament 

 

 

14

Values of upto A of seperation between the talus and distal tibia are considered normal 

Values between B and C may be normal or abnormal and the opposite ankle should be tested

Values above D are always abnormal 

A: 5mm

B: 5mm and C: 10mm

D: 10mm

15

What are the primary goals for management of ankle fractures?

 

  • Restore function 
  • Return to normal function 

16

What are different types of fractures?

Hint: 8 different 

 

  1. Spiral
  2. Oblique
  3. Transverse 
  4. Comminuted
  5. Wedge
  6. Impacted/Compression
  7. Displaced
  8. Open or compound

17

Supination Adduction 

It occurs in A% of ankle fractures

The foot is fixed on the ground in B position with an C force is applied to the talus

 

 

 

 

 

A: 20-25%

B: Supination C: Adduction 

18

Suppination Adduction 

Stage 1

Supination results in a tear of the A ligament

or

An B fracture of the C below the level of tibial plafond

 

A: Lateral collateral ligament

B: avulsion 

C: Lateral malleolus

 

19

Supination Adduction 

Stage 1

A rupture with or without B fragment and or C fracture of D malleoli below the ankle mortise 

 

 

A: lateral ligament 

B: Avulsion 

C: transverse 

D: lateral 

 

20

Supination Adduction

Stage 2

A fracture of the B malleoli 

 

 

A: Vertical 

B: Medial 

 

21

Supination Adduction

Stage 2

More talar tilt results in the medial malleolus being 

pushed of in a A or B way 

 

 

A: Vertical 

B: Oblique 

22

What is the name of this fracture?

 

Supination Adduction

 

23

What does the grey arrow show?

What does the orange arrow show?

Grey arrow: Lateral injury, transverse fibular fracture below or at the level of mortise

Orange arrow: Medial injury, vertical shear type, medial malleolar fracture 

 

24

Pronation- Abduction 

It occurs very A

Stage 1: B medial C fracture 

Or D ligament rupture

 

A: Rarely 

B: Transverse        C: Malleoli

D: Deltoid 

25

Pronation Abduction

Stage 2: As the abductory force continues to push the talus A

Creating injury to both B and C

In this stage the D is still intact 

Pronation Abduction 

A: Laterally 

B: Anterior tibiofibular 

C: Posterior tibiofibular 

D: interossious ligament

26

Pronation Abduction 

Stage 3: In this stage the abductory force has continued into the fibula creating a fracture at A

that is B on AP view

But appears C on a lateral view 

Pronation Abduction 

 

A: at or above the ankle joint 

B: short and oblique

C: transverse 

 

 

27

Pronation Abduction 

Stage 3: A fracture typically proximal to mortise

often with a B fragment 

The lateral view is important to differentiate it from 

C fracture 

 

Pronation Abduction 

A: Fibula

B: Butterfly 

 

C: Supination Eversion 

 

28

Supination External rotation 

This is the A common fracture 

In stage 1:

Rupture of B ligament 

Or a fracture of C, also known as D

Supination External rotation 

A: Most common 

B: Anterior tibiofibular ligament

C: Lateral distal tibia

D: Tillaux- Chaput fracture 

 

 

29

Supination External Rotation 

Stage 2: Spiral fracture of A at the B level 

The most commonly encountered ankle fracture

 

Supination External Rotation

A: Fibula 

B: Syndosmotic level 

30

Supination- External Rotation 

Stage 3: As the force progresses it will involve either a rupture of A 

Or the fracture of B of the tibia 

Also known as the C fracture 

 

 

Supination- External Rotation 

A: Posterior tibiofibular ligament

 

B: Posterior Malleolus of the tibia

C: Volkman's fracture