ANKLE FRACTURES AND FRACTURE-DISLOCATION.

• Fractures and fracture-dislocation of the ankle are common.

• Mechanisms ; twisting slipping.• The injury may be caused by direct

trauma.

CLASSIFICATION.

• Fractures of the ankle can be classified according to ;

Mechanism of injury. The Lauge-Hansen classification. This classification is very complex.

Anatomical . The relation of the fracture of the fibula to the syndesmosis ; Weber A , Weber B and Weber C.

CLINICAL FEATURES.

History of twisting the ankle.Clinically the ankle is swollen, deformed ( if

there is fracture-dislocation), and tender.Identify areas of tenderness because they

are a clue to the diagnosis and treatment.Commonly closed injuries.

INVESTIGATIONS.

• A fracture-dislocation of an ankle is a clinical diagnosis. The dislocation must be reduced and the ankle immobilized before sending patient to X-rays.

• You must request three X-rays ; AP, LATERAL AND OBLIQUE. Each X-ray film must include the ankle and knee joints.

PRINCIPLES OF TREATMENT.

Reduce fracture-dislocations urgently.Always splint the ankle.Elevate the ankle to decrease swelling.We operate all ankle fractures except those with a

minimally displaced lateral malleolus with no medial tenderness.

Fracture of an ankle unites in six weeks.

COMPLICATIONS.

• EARLY ;Skin breakdown esp. In fracture-dislocation.Vascular damage.Swelling plus blisters.

COMPLICATIONS ……..

• Late ; Malunion. Non-union. Joint stiffness. Osteo-arthritis. Complex regional pain syndrome.

THE END.