LL: ANKLE FRACTURES AND DISLOCATIONS

Question 1

Ankle fractures and dislocations

CAUSES & COMPLICATIONS

Answer 1

Direct trauma
Rotatory, inversion or eversion forces
Fall from a height
Compression during MVA

COMPLICATIONS
Loss of ankle range of motion
Post-traumatic osteoarthritis

Question 2

Ankle fractures and dislocations
classifications:
WEBER A

Answer 2

Weber A
(supination- adduction)
1. Infrasyndesmotic #
2. Syndesmosis is intact & tibio-fibular ligaments are intact
3. Transverse fracture of the fibula below the level of the syndesmosis
4. Tension or avulsion of the lateral collateral ligament
Type 1 – isolated fibular fracture
Type 2 – associated fracture of the medial malleolus
Type 3 – medial malleolar fracture extends posteriorly around the tibia

Question 3

Ankle fractures and dislocations
classifications:
WEBER B

Answer 3

Weber B
(supination-eversion)
1. Syndesmotic #
2. May have rupture of anterior syndesmosis & therefore tibio-fibular
ligament rupture (but the mortise is stable following reduction of the
fracture)
3. Rupture of the posterior syndesmosis
Type 1 – isolated fibular fracture
Type 2 – associated medial ligament rupture and/or avulsion #
Type 3 – associated medial ligament rupture and/or avulsion # as well
as fracture of the posterolateral tibia

Question 4

Ankle fractures and dislocations
classifications:
WEBER C

Answer 4

Weber C
(pronation-eversion)
1. Suprasyndesmotic #
2. Syndesmosis is completely disrupted
3. Avulsion # or rupture of medial ligament
4. Fracture of the diaphysis of the fibula
5. Rupture of the posterior syndesmosis
Type 1 – fibular fracture is simple
Type 2 – fibular fracture is segmental/comminuted
Type 3 – fibular fracture is very proximal

Question 5

TREATMENT=Fractures of one malleolus with no talar shift:

Answer 5

TREATMENT
The treatment of ankle fractures is based on the stability and degree of
displacement. This may be categorised as follows:

Fractures of one malleolus with no talar shift:
Below knee POP, then elevate for 2-5/7
Apply walking heel and mobilise PWB/FWB for 6/52

CONTRA-INDICATIONS AND PRECAUTIONS
Avoid isometric inversion and eversion for the first few weeks.
Do not use the foot or ankle as a point of resistance for hip and knee
strengthening exercises.
General contra-indications.

Question 6

TREATMENT OF Fractures of two or three malleoli where there is already or is potential
for talar shift

Answer 6

TREATMENT
The treatment of ankle fractures is based on the stability and degree of
displacement. This may be categorised as follows:

Fractures of two or three malleoli where there is already or is potential
for talar shift
May treat with POP as above
ORIF is usually done with screws, K-wires or tension-band wiring. Plates are
also used occasionally.
Elevate for ±5/7, then below knee POP is applied and the patient can mobilise
NWB for 6/52. A walking heel is then applied and the patient can mobilise
PWB to FWB over 4-6/52.

CONTRA-INDICATIONS AND PRECAUTIONS
Avoid isometric inversion and eversion for first few weeks.
Do not use the foot or ankle as a point of resistance for hip and knee
strengthening exercises.
General contra-indications.

Question 7

TREATMENT OF Injuries with complete disruption of the syndesmosis

Answer 7

TREATMENT
The treatment of ankle fractures is based on the stability and degree of
displacement. This may be categorised as follows:
Injuries with complete disruption of the syndesmosis
These should always be treated with ORIF. In addition to the malleoli being
fixed as described above, a syndesmosis screw is inserted to stabilise the
syndesmosis.

CONTRA-INDICATIONS AND PRECAUTIONS
Avoid isometric inversion and eversion for the first few weeks.
Do not use the foot or ankle as a point of resistance for hip and knee
strengthening exercises.
General contra-indications.

Question 8

TREATMENT & CONTRAINDICATIONS OF COMRESSION FRACTURES

Answer 8

Compression fractures
These may be treated with ORIF as described above, or the patient may be
put on calcaneal skeletal traction.

CONTRA-INDICATIONS AND PRECAUTIONS
No resisted plantar flexion.
General contra-indications.

Question 9

TREATMENT OF ANKLE DISLOCATION

Answer 9

TREATMENT
The treatment of ankle fractures is based on the stability and degree of
displacement. This may be categorised as follows:

Ankle dislocation
A dislocated ankle is a severe injury.
Usually happens in conjunction with a fracture or complete rupture of
ligaments.
A dislocated ankle can be a posteriorly, anteriorly or superiorly.