The most common ankle fractures are breaks of the lateral malleolus. These views were imported into macromedia fireworks mx software macromedia, san francisco, ca to overlap and orient fracture patterns onto a 3d template image of an intact ankle. Lateral malleolus avulsion fracture discharge advice. Fractures can occur at different levels of the medial malleolus.
However, beware the nondisplaced ankle fracture presenting postinjury with minimal swelling and no deformity. Displaced fractures are commonly treated with an open reduction and internal fixation. These injuries typically occur when the ankle is either twisted or rolled, often with an awkward or uneven step. Posterior malleolus fracture a posterior malleolus fracture is a fracture of the back of the shin bone at the level of the ankle joint. Within the present study, a 19yearold female who sustained an isolated lateral malleolar fracture was treated with open reduction and intramedullary mg screw fixation and then followed up. Isolated fracture of the lateral malleolus requires no. The control material is composed of the series reported by. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities. Mri to evaluate all patients with lateral malleolar fracture and positive stress test n21.
Osteomed rethinking possibilities, reshaping lives. Utilizing the locking peg hook plate for a comminuted. Ankle fracture indication for ortho referral weber type b, c bi or trimalleolar fracture posterior malleolar fracture with 25% articular involvement or 2mm step off lateral malleolus fracture displaced 3mm displaced medial malleolar fracture. This view visualizes both the lateral and medial joint spaces. Pdf isolated lateral malleolar fracture treated with a.
The ideal treatment of a posterior malleolar fracture fragment pmf is an ongoing debate in the. A posterior subtalar effusion seen on the lateral view is. The key role of the lateral malleolus in displaced fractures. In such cases, medial and posterior malleolar fractures can be seen, while the lateral force in the fibula at the syndesmosis in this mechanism of injury may not be enough to result in a lateral malleolus fracture6. It is also gradually being recognised that the integrity of the medial column is essential for the stability of the fracture. Stable fractures of the ankle can be safely treated nonoperatively.
The good news is that most lateral malleolus fractures are considered. At times the talus may completely pop out of the ankle joint associated with the fracture, in which case we call this a fracture dislocation. The lateral malleolus is the name given to the bone on the outside of the ankle joint. Ankle fractures symptoms, diagnosis and treatment bmj.
All of the fractures were evaluated based on herscovici medial malleolar fractures classification. This secondmost common type involves breaks of both the lateral malleolus and of the medial malleolus, the knobby bump. It is associated with an oblique fibular fracture and often occurs at the corner of the ankle joint. Case report lateral malleolar fracture with concurrent achilles tendon rupture. Ankle fractures represent the most common types of lower extremity bony injury with an incidence between 100 and 150 per 100,000 personyears and rising. It is a break of the lateral malleolus, the knobby bump on the outside of the ankle in the lower portion of the fibula. Comparison of three posterior malleolar fixation methods in. There is also the anterior tubercle with the anterior. The initial injury in 2003 revealed a weber b lateral malleolus fracture, a nondisplaced posterior malleolar lip fracture, and a herscovici type c transverse medial malleolus fracture, ota ao44b3. The fracture has occurred in a part of the bone which normally heals well without problems. These may involve only the medial malleolus, the fibula, or both bones which is called a bi malleolar fracture.
Small nondisplaced avulsion fractures of the tip of the lateral malleolus figure 4 are best treated with early mobilization similar to treatment of an ankle sprain. Ankle fractures clas sically refer to malleolar injuries. Malleolar fractures of ankle are usually complex injuries, as they. Lateral malleolus hookplate fixation in the treatment of herscovici. Often, the lateral malleolus is also fractured because it shares ligament attachments with the posterior malleolus. Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral malleolus following a.
According to a study by gardner et al8, a significant number of trimalleolar ankle. Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation 25. A lateral malleolar fracture, the anterior tibiofibular ligament and the syndesmosis are exposed through an anterolateral incision placed exactly over the. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. Posterior malleolus fracture displacement is associated. Magnesium mg bioabsorbable screws are new biomaterials used in fracture fixation. Physical therapy guidelines for ankle fracture with surgery. Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. Thus, this could be a better surgical treatment for ankle fractures. Cureus isolated lateral malleolar fracture treated with a. Jun 22, 2020 the oblique medial malleolar fracture generally occurs along with a rotational injury that starts on the outside of the ankle.
Management of ankle fractures rhode island medical society. Concerns risk for nonunion due to intraarticular nature of fracture risk for delayed union and late displacement rate of physeal arrest may be than the literature suggests abbott et al posna 2015 42 pediatric medial malleolus fractures with 3 months followup 52% developed a physeal bar. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. Weber classification of ankle fractures radiology reference. The pain, tenderness and swelling you are experiencing. It is generally thought that bi and tri malleolar fractures are unstable, as are pronation external ro. The technologist turns the foot inwards until the lateral malleolus is at the same height as the medial malleolus. Sep 01, 2002 orly to the tip of the lateral malleolus. Ankle fracture postop rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement.
There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. Operative treatment of posterior malleolar fractures. In the current literature, there is only one case report on the use of magnesium bioabsorbable screws in ankle fractures. Diagnosis ankle fractures usually result from torsional forces and present typically with tenderness, swelling, deformity and inability to weightbear. Bimalleolar fracture is a fracture of both the medial malleolus and the lateral malleolus. The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood. Postoperatively, radiographs was used to assess the quality of. Isolated nondisplaced lateral malleolar fractures have a low risk of complications and have good clinical results regardless of treatment. Results there were 52 cases of weber type b lateral malleolar fractures and cases of wagstaffe fractures combined with them 25%. Quantification of threedimensional computed tomography q3dct was used as a reference.
In stages ii to iv, the lateral side of the ankle is sequentially injured. Isolated lateral malleolus fracture with medial malleolus fracture or deltoid ligament rupture. May 23, 20 60% of ankle fractures involve only the lateral malleolus. There is the medial malleolus with the deltoid complex 1 and the lateral malleolus with the lateral ligaments 2. Management of fracture of posterior malleolus, trimalleolar. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. The most common ankle fractures are breaks of the lateral malleolus end of the fibula, medial malleolus inside end of the tibia or both, which is called a bimalleolar fracture. Associated syndesmosis widening or medial injury, bony or ligamentous, make the choice of treatment fairly simple and obvious.
Management of isolated lateral malleolar fracture the egyptian. Surgical management of posterior malleolus fracture aimdr. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or with an injury to the ankle ligaments. These fractures are more common in women nearly 60 percent than men. Trimalleolar fracture is a fracture of the lateral malleolus, medial malleolus, and posterior aspect of the distal tibial articular surface. Pediatric ankle fractures orthopaedic trauma association. Percutaneous lateral malleolar transtibial pin fixation of unstable ankle fractures. In fracture management for primary care third edition, 2012.
Only a few have studied the prognosis of lateral malleolar pseud arthrosis. On a true apview the talus overlaps a portion of the lateral malleolus, obscuring the lateral aspect of the ankle joint. Anatomy, classification, and management of ankle fractures. Cureus isolated lateral malleolar fracture treated with. A bimalleolar fracture is a fracture of the distal tibia and fibula in which the medial malleolus of the distal tibia and the lateral malleolus of the distal fibula are fractured. These materials are listed in table 1 from which it is apparent that pseudarthrosis of thc lateral malleolus seems to develop in about one per cent of con servatively treated fractures. Malleolar fractures include injuries of bones malleoli and or ligaments. The aim of this study was to describe the epidemiology of ankle fractures treated at sahlgrenska university hospital su during a 2year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar.
May be associated with a dislocation of the ankle joint. Isolated fracture of the lateral malleolus requires no treatment. The pain, tenderness and swelling you are experiencing in the foot should gradually settle over a period of several weeks. If deep deltoid partially intact nonop treatment good clinical outcomes. Kissel2 1podiatric medicine and surgery resident, detroit medical center, 4201 st. Distribution of the lateral malleolar pseudarthroses of the followup material bg tvpe and stage of fracture compared with the distribution in a control material of ankle fractures.
Images of each posterior malleolar fracture generated with our q3dctmodeling techniques in. There is a second joint between the tibia and fibula called the syndesmosis that may also be injured. Antoine, uhc 9c, detroit, mi 48201, usa 2section of podiatric surgery, detroit medical center, 6071 w. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Classification and treatment of lateral malleolar fractures a single. The patient underwent orif utilizing a standard lag screw and a onethird tubular neutralization plate for the lateral. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus. When is a simple fracture of the lateral malleolus not so.
Weber b fracture of the lateral malleolus with concomitant. Pseudarthrosis of the lateral malleolus 191 table 3. Most often, ankle fractures occur due to a quick twisting injury where the foot is planted on the ground and the body rotates around it. The commonly used weber classification relies solely on the level of the lateral malleolar fracture relative to the ankle joint line. The weber ankle fracture classification or danisweber classification is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. Lateral malleolar fracture an overview sciencedirect topics. There is the medial malleolus with the deltoid complex 1 and the lateral malleolus with.
Lateral malleolar fractures at the level of the syndesmosis, aoota 44 b fractures, are the fourth most common fracture registered in the sfr. Fractures of the lateral malleolus are the most common type of fracture. Anatomic study of exposed posterior malleolus using the. Discharge advice you have fractured a bone on the outer part of your ankle.
A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. Commonly a lowenergy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus. Classification and treatment of lateral malleolar fractures. Mcgarvey, in baxters the foot and ankle in sport second edition, 2008 lateral fractures. Ig yablon, fg heller and l shouse the key role of the lateral malleolus in displaced fractures of the ankle this information is current as of may 25, 2009 reprints. Lateral malleolar fracture an overview sciencedirect. All patients were subjected to plane radiographs of ankle ap and lateral views. Aug 05, 2020 the decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat nonsurgically is a matter of debate. Guesstimation of posterior malleolar fractures on lateral. Can be associated with a disruption of the tibiofibular syndesmosis. Prepare the fracture, fusion, or osteotomy site using the surgeons preferred technique. Jan 20, 2016 the laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury.
Foot fractures frequently misdiagnosed as ankle sprains. Dec, 2019 it is estimated that posterior malleolar fractures are found in 40% of rotational ankle fractures, but they may also occur in isolation, as a component of pilon fractures, or as a component of a distal tibia fracture. The pdf of the article you requested follows this cover page. The presence of an oblique medial malleolar fracture is generally indicative an unstable ankle. A lateral flat or precontoured plate is placed on the reduced fracture and fixed with locked or unlocked screws. Surgical treatment of lateral malleolus fractures associated with unstable ankle injuries has been shown to improve patient outcomes over nonoperative management. The tibia and fibula form a joint around the talus bone called the ankle joint. Malleolar either medial or lateral bimalleolar both medial and lateral trimalleolar includes posterior malleolus the direction of the force determines the fracture pattern external rotation, abduction, adduction. Single malleolar fracture is a lateral or medial malleolar fracture. Isolated lateral malleolar fractures present one of the most challenging management dilemmas in the realm of sports injuries. The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade. Lateral malleolar fracture with concurrent achilles tendon. The more bones that are broken, generally the worse the injury. Omt of the lower extremity florida osteopathic medical.
85 954 1274 1353 945 328 199 1135 1345 873 1171 140 1536 1401 1038 953 1388 452 190 1434 542 462 776 1393 319