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Ankle Fractures

Ankle Fractures. Justin Mullner – 8/27/09. Outline. Anatomy and common ankle views Ottawa Ankle Rules Classifications (Weber, Lauge-Hansen) Biomechanics Named fractures. LATERAL VIEW. AP VIEW. MORTISE VIEW. Lateral Ankle Ligaments. Medial Ankle Ligaments.

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Ankle Fractures

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  1. Ankle Fractures Justin Mullner – 8/27/09

  2. Outline Anatomy and common ankle views Ottawa Ankle Rules Classifications (Weber, Lauge-Hansen) Biomechanics Named fractures

  3. LATERAL VIEW

  4. AP VIEW MORTISE VIEW

  5. Lateral Ankle Ligaments Medial Ankle Ligaments CFL = Calcaneofibular ligament PTFL = Posterior talofibular ligament ATFL = Anterior talofibular ligament Deltoid Ligament

  6. Ottawa Ankle Rules Before introduction of the rules, all injured ankles were X-rayed but only 15% were positive for fracture The ankle is the most commonly injured weight bearing joint Unnecessary X-rays: costly, time consuming, and possible health risk

  7. Ottawa Ankle Rules • X-rays are only required if there is bony pain in the malleolar zone AND any one of the following: • 1 – Tenderness along the distal 6cm of the posterior edge of the tibia • 2 – Tenderness along the distal 6cm of the posterior edge of the fibula • 3 – Inability to bear weight immediately after injury and in the ER

  8. Ottawa Ankle Rules

  9. Classification Schemes • Danis-Weber system • Level of the fibular fracture in relationship to the ankle joint (A, B, C) • Ideal for the primary care setting– allows you to classify the injury easily and guides treatment • Lauge-Hansen system • 2-word descriptors detailing position and motion of the foot each with 2-4 stages specifying exact locations of fractures • More descriptive but very complicated • i.e. pronation-abduction-stage 2

  10. Biomechanics Dorsiflexion Eversion Adduction Plantarflexion Inversion Abduction

  11. Biomechanics Simple unidirectional forces can be involved in an ankle injury resulting in ligamentous damage and isolated fractures Multidirectional forces are usually involved making diagnosis a challenge

  12. Biomechanics • Lateral Complex • Distal fibula • Lateral facet of the talus • Lateral ligaments of the ankle • Subtalar joints • Lateral complex injuries typically occur with inversion and supination • The most common ankle injury

  13. Biomechanics Inversion force avulses the lateral malleolus and continued force causes oblique fracture of the distal tibia

  14. Biomechanics • Medial Complex • Medial malleolus • Medial facet of the talus • Superficial/deep deltoid ligament • Medial complex injuries typically occur from eversion and abduction

  15. Biomechanics Eversion force avulses the distal medial malleolus (young/elderly) and continued force results in rupture of the syndesmosis or transverse fracture of the distal fibula

  16. Biomechanics Horizontal avulsion fracture through the medial malleolus and oblique-vertically oriented compression fracture through the distal fibula. The syndesmosis is disrupted and abnormally widened, with no overlap between tibia and fibula

  17. MAISONNEUVE FRACTURE -Proximal half of fibula -Strong eversion -The more proximal the fracture, the more unstable the joint

  18. TILLAUX FRACTURE Lateral margin avulsion of the distal tibia Abduction + External Rotation Typically occurs in adolescents after medial epiphyseal plate closes but before the lateral (18 month window)

  19. 1 = vertical frxr thru the epiphysis TRIPLANE FRACTURE 2 = horizontal frxr thru the physis 3 = oblique frxr thru the metaphysis Twisting Injuries - adolescents

  20. PILON FRACTURE TRAUMA!!

  21. TRIMALLEOLAR FRACTURE • Can be caused by talar eversion and posterior displacement • Also known as a Henderson fracture

  22. Questions?

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