6 of the patients treated in the study had excellent results after 2.5 years of follow up, the other 2 had good results after 2.5 years.Įxample of a representative fixation construct of the injury is shown in Illustration A. Weber B ankle fractures were defined as stable when having a medial clear space (MCS) of < 7 mm on initial gravity stress radiographs and a normal mortise. Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications. posterior malleolus fractures <25 of joint surface and <2mm articular step-off can be treated non-operatively in short leg walking cast vs. In the referenced article by McConnell et al, 8 ankle fractures of this variety were all treated with open reduction and internal fixation, two with medial screws perpendicular to the fracture and the other 6 with medial screws and a one third tubular antiglide plate. Of all patients undergoing ankle fracture fixation, approximately 13 are diabetic and 2 have complicated diabetes mellitus. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus.Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. Screws alone or a tension band would not provide a vertically stable construct. A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. The correct treatment for this type of injury is open reduction and internal fixation (ORIF) with correction of the impacted articular component. As the talus continues to invert, the medial malleolus is pushed to failure and fractures in a vertical fashion. The initial injury is a rupture of the lateral ankle ligaments or avulsion of the lateral malleolus. Although treatment of associated lateral and medial. The mechanism of a supination–adduction injury to the ankle results in a low transverse lateral malleolus avulsion and a vertical fracture of the medial malleolus secondary to inversion of the talus in the ankle mortise. Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. This type of injury is also associated with hyperdorsiflexion. Conditions such as diabetes or advanced age are no longer contraindications to usual management recommendations.A supination-adduction type injury consists of a vertical displaced medial malleolus fracture with marginal impaction of the tibial plafond and a low transverse fibula fracture. However, the choice between metal and bioabsorbable screws, screw size, number of cortices fixed, and indications for screw removal remain controversial. Ankle fractures with syndesmotic injury have additional tibiofibular instability that can be controlled by screw fixation. If necessary, the syndesmosis can be reduced open, with screw fixation placed parallel to the joint. After placement of plate and screws, intraoperative stress tests can be used to assess for syndesmotic widening. A posterior malleolar fracture should be reduced and stabilized if it comprises >30% of the articular surface and remains displaced after fibular stabilization. Methods: SER type 4 ankle fractures are considered unstable and are generally treated with surgical fixation. Stress radiographs may aid in the management of incomplete deltoid injury in which there is medial swelling and tenderness without radiographic talar shift. 354 likes, 3 comments - orthobulletsofficial on November 11, 2021: Displaced ankle fractures with evidence of syndesmosis injury should be managed. Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol. Diagnosis is made radiographically with displaced injuries but CT/MRI may be required to diagnosis nondisplaced fractures. determine what forces (varus/valgus) on AP fluoro are needed for reduction under traction. Isolated medial or posterior malleolar fracture. anticipate what will be used for definitive fixation and ensure pins do not imede. common ankle fracture type in this age group.28 Elderly women are especially at risk, since women over 60 years with bi- or trimalleolar fracture have the highest incidence of open ankle fractures.29 Due to the predominance in elderly women, some authors claim that trimalleolar frac-tures should be regarded as fragility fractures. want pins to be at least 3cm proximal to fracture. Stable fractures (eg, isolated lateral malleolar) generally are managed nonsurgically unstable fractures (eg, bimalleolar, bimalleolar equivalent) usually are managed with open reduction and internal fixation. An anterior superior iliac spine (ASIS) avulsion is a traumatic avulsion of the ASIS due to a sudden and forceful contraction of the sartorius and tensor fascia lata that occurs in young athletes. mark out proximal extent of fracture in distal tibia using fluoro. Ankle fractures are among the most common skeletal injuries selection of an optimal management method depends on ankle stability.
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