Ankle FracturesAnkle Fractures

POTT’S FRACTUREPOTT’S FRACTURE

Malleolar FracturesMalleolar FracturesInjuries about the ankle joint cause destruction Injuries about the ankle joint cause destruction

of not only the bony architecture but also of not only the bony architecture but also often of the loften of the ligamentous igamentous and and soft tissuesoft tissue

components.components.

AnatomyAnatomy

Mechanism of injuryMechanism of injury The patient stumbles and falls with the foot The patient stumbles and falls with the foot

anchored to the ground and the body with anchored to the ground and the body with the ankle joint twists.the ankle joint twists.

Mechanism of injuryMechanism of injury There may be fracture of one or both There may be fracture of one or both

malleoli or one malleolus and the opposite malleoli or one malleolus and the opposite ligaments.ligaments.

If the malleolusIf the malleoluspushed the fracture pushed the fracture is oblique; if its pulled the is oblique; if its pulled the fracture is transverse.fracture is transverse.

Danis -Weber classificationDanis -Weber classification Based on the location and appearance of the Based on the location and appearance of the

fibular fracture:fibular fracture: Type A:Type A: caused by internal rotation and caused by internal rotation and

adduction that produce a transverse fracture adduction that produce a transverse fracture of the lateral malleolus at or below the of the lateral malleolus at or below the plafond, with or without an oblique fracture of plafond, with or without an oblique fracture of the medial malleolus.the medial malleolus.

Type B:Type B: caused by external rotation that caused by external rotation that results in an oblique fracture of the lateral results in an oblique fracture of the lateral malleolus.malleolus.

The injury may include rupture or avulsion of The injury may include rupture or avulsion of the anteroinferior tibiofibular ligament, fracture the anteroinferior tibiofibular ligament, fracture of the medial malleolus, or rupture of the of the medial malleolus, or rupture of the deltoid ligament.deltoid ligament.

Type C:Type C: fractures are abduction injuries with fractures are abduction injuries withoblique fracture of the fibula proximal to the oblique fracture of the fibula proximal to the

disrupted tibiofibular ligaments ;medial disrupted tibiofibular ligaments ;medial malleolar fracture or a deltoid ligament malleolar fracture or a deltoid ligament rupture.rupture.

Fracture of the posterior malleolus may Fracture of the posterior malleolus may accompany type C fractures. accompany type C fractures.

Clinical featuresClinical featuresSkiersSkiers, , footballersfootballers, , climbersclimbers and and RTARTA..Pain, inability to stand, swelling, Pain, inability to stand, swelling,

deformity, echymoses and skin deformity, echymoses and skin blistering.blistering.

X-ray:X-ray: APAP, , laterallateral, , 30° oblique views of 30° oblique views of the ankle (mortise).the ankle (mortise).

Lateral and medial malleolus, posterior tibial Lateral and medial malleolus, posterior tibial edge (posterior malleolus), tibio fibular edge (posterior malleolus), tibio fibular syndesmoses (diastases). syndesmoses (diastases).

TreatmentTreatmentPrinciples:Principles:1.1. Don’t delay.Don’t delay.2.2. Treat the bony and ligament injuries.Treat the bony and ligament injuries.3.3. Accurate reduction and maintaining it.Accurate reduction and maintaining it. Conservative treatments:Conservative treatments:Used for non displaced type A and B injuries.Used for non displaced type A and B injuries.Below knee posterior slab for 5 days with Below knee posterior slab for 5 days with

elevation, then check X-ray if still non elevation, then check X-ray if still non displaced full POP cast for 6-8 weeks.displaced full POP cast for 6-8 weeks.

Operative treatments:Operative treatments:For displaced type A& B and all type C Injuries.For displaced type A& B and all type C Injuries.Open reduction and internal fixation in steps:Open reduction and internal fixation in steps:1.1. Lateral malleolus:Lateral malleolus:Perfect reduction and fixation by plate and Perfect reduction and fixation by plate and

screws (most important step).screws (most important step).2.2. Medial malleolus:Medial malleolus:Reduction after removing the periostium and Reduction after removing the periostium and

fixation by two malleolar screws.fixation by two malleolar screws.

3.3. Transverse screwTransverse screw if the syndesmoses is if the syndesmoses is unstable.unstable.

4.4. Posterior malleolusPosterior malleolus if large fix by one screw. if large fix by one screw.

Postoperative treatment:Postoperative treatment:Below knee posterior slab for 5 days with elevation, Below knee posterior slab for 5 days with elevation,

followed by full POP walking cast for 6-8 weeks.followed by full POP walking cast for 6-8 weeks.Complications: Complications: EarlyEarly1.1. Vascular injuryVascular injury: if fracture subluxation of the : if fracture subluxation of the

ankle joint.ankle joint.2.2. Wound breakdown and infection.Wound breakdown and infection.Late:Late:1.1. Malunion.Malunion.2.2. Non union (medial malleolus).Non union (medial malleolus).3.3. Stiffness.Stiffness.4.4. Osteoarthrits.Osteoarthrits.