Spiral fracture distal fibula11/25/2023 ![]() The lateral ligaments are the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) and these connect the lateral malleolus to the talus. The syndesmosis between the fibula and tibia is formed by the anterior and posterior inferior tibiofibular ligaments (AITFL and PITFL) and the interosseus ligament, which is the lower part of the interosseus membrane. The lateral column consists of the fibula, the syndesmosis and the lateral ligaments. The ankle is also divided into two columns: lateral and medial. If this ‘ring’ is broken at one site only, it remains stable, but if it is broken at two or more sites, it becomes unstable. The ankle joint can be considered as a ‘ring’ in which bones and ligaments contribute to the overall stability. This review will analyse the principles of stability assessment for ankle fractures and provide a rationale for diagnosis and management.Īpplied anatomy, biomechanics, and classifications However, more complex injuries, such as those involving the posterior structures, require in-depth knowledge of the fracture pattern and careful evaluation and planning of any surgery. 1, 3 Internal fixation can lead to surgical complications in up to 20% of cases 4, 5 and is therefore best avoided for those fractures where non-operative management can offer optimal outcomes. To illustrate, the second of these statements is based on an article published in 1940 reviewing only eight ankle fractures involving the posterior malleolus. 1, 2 The orthopaedic and trauma community needs to move away from the almost anecdotal ‘principles’ suggesting, for example, that 2 mm displacement of a distal fibula fracture requires surgical reduction and fixation, or that posterior malleolus fractures affecting less than 25% of the tibial plafond can be treated non-operatively. As such, it has become apparent that the ‘key issue’ in achieving good outcomes when treating these common injuries is to follow the principle of restoring the stability and alignment of the fractured ankle, using either non-operative or operative treatment, as appropriate. As scientific (laboratory, cadaveric and clinical) research has led to better understanding of the biomechanics and patho-anatomy of the ankle, this has allowed more accurate evaluation of all elements and characteristics of injuries to bone and soft tissues associated with malleolar fractures. Management of ankle fractures has evolved over the last 10 years. Fractures of the Ankle Joint: Investigation and Treatment Options. Goost H, Wimmer M, Barg A, Kabir K, Valderrabano V, Burger C. Evaluation of the Syndesmotic-Only Fixation for Weber-C Ankle Fractures with Syndesmotic Injury. CURRENT Diagnosis & Treatment in Orthopedics, Fourth Edition. Musculoskeletal Eponyms: Who Are Those Guys? Radiographics. Usually associated with an injury to the medial side Weber C fractures can be further subclassified as 6Ĭ1: diaphyseal fracture of the fibula, simpleĬ2: diaphyseal fracture of the fibula, complexĪ fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint Medial malleolus fracture or deltoid ligament injury often presentįracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs ( Maisonneuve fracture) Tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation ![]() Weber B fractures could be further subclassified as 9ī2: associated with a medial lesion (malleolus or ligament)ī3: associated with a medial lesion and fracture of posterolateral tibiaĪbove the level of the syndesmosis (suprasyndesmotic) Variable stability, dependent on the status of medial structures (malleolus/ deltoid ligament) and syndesmosis may require open reduction and internal fixation (ORIF) Tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injuryĭeltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome Usually stable if medial malleolus intact treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeksĭistal extent at the level of the syndesmosis (trans-syndesmotic) may extend some distance proximally Below the level of the syndesmosis (infrasyndesmotic) ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |