Surgical management of bimalleolar fractures of ankle 472 p j m h s vol. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Fractures in the ankle can range from the less serious avulsion injuries small pieces of bone that have been pulled off to severe shatteringtype breaks of the tibia, fibula or both. People involved in a wide range of athletic activities, including ballet dancers, snowboarders, basketball players and skydivers, are at high risk of ankle fractures because of the physical demands placed on their ankles. Ankle fractures are common, with an incidence of up to 174 cases per 100 000 adults per year. Rehabilitate r esuscitate advanced trauma life support. May 29, 2017 ankle fractures are the third most common osseous injury in the elderly, behind hip and distal radius fractures. This is because it shares ligament attachments with the posterior malleolus. Physical therapy guidelines for ankle fracture with surgery.
Management may be operative or nonoperative, depending on the severity of the injury and the patients overall health and functional status. Commonly a lowenergy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus. May 23, 2014 fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. The management of neuroarthropathic fracturedislocations in the diabetic patient. Ankle fracture dislocations will become more common in wilderness and outdoor situations as the large population of baby boomers continues to remain active even at advanced ages. Ankle fractures are common and the majority are the result of low energy torsional trauma. Management is determined by the location of the fracture and its effect on balance and weight bearing. A posterior malleolus fracture is a fracture of the back of the tibia at the level of the ankle joint. These complications may lead to repeated operations, prolonged hospitalizations, and intravenous antibiotics. Fracture of the base of the 5th metatarsal is one of these. Successful management of these injuries begins in the field, where accurate reduction of a displaced fracture may restore lost neurovascular function, decrease pain. Ankle fracturedislocations will become more common in wilderness and outdoor situations as the large population of baby boomers continues to remain active even at advanced ages.
Jan 22, 2020 ankle fractures are common injuries among people of all ages, interests and lifestyles. Ankle injuries are among the most common of the bone and joint injuries. Weber classification of ankle fractures assoc prof craig hacking and assoc prof frank gaillard et al. Oct 28, 2011 as with all fractures, the aims of definitive management of ankle fractures are to. Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. Mathes ankle fractures breaks are very common injuries that usually happen from a fall where the ankle is twisted or rolled or there is high.
While there is a rich history of clinical advancement in the timing, technique, perioperative management, and associated risks of hip fractures. Manual of fracture management foot and ankle 1st edition. This article will present principles of ankle fracture management, including fixation techniques and constructs that may facilitate improved outcomes in treating diabetic ankle. If the fracture is displaced, the only option is open reduction and internal fixation. Stable, nondisplaced fractures are typically managed nonoperatively, while displaced, unstable ankle fractures typically require open reduction and internal fixation. Although non operative management carries an increased risk of. Mri to evaluate all patients with lateral malleolar fracture and positive stress test. Understanding the diagnosis and management of these injuries is.
Accuracy of bedside ultrasonography for the diagnosis of finger fractures. Vlp foot, ilizarov, cannulated screws, periloc locked plating, periloc vlp, jetx, tc100. Ankle fractures foot health facts foot health facts. Management of ankle fractures in children request pdf. This is a followup leaflet to your recent telephone consultation with the fracture care team explaining the ongoing management of your injury. Epidemiology and treatment results for ankle fractures at. Can be associated with a disruption of the tibiofibular syndesmosis. Ankle fracture, the swedish fracture register, epidemiology, fracture management. Use the ottawa ankle and foot rules to determine whether xrays are needed in a patient with foot pain and a suspected fracture. There is a vast amount of literature on the management of geriatric ankle fractures with studies supporting both operative and nonoperative treatments.
Stability and congruency of the ankle joint are the main factors that determine prognosis and overall management. Mar 14, 2012 rotational fracture of the ankle can be viewed as a continuum,progressing from single malleolar fractures to bimalleolar fractures tofractures involving the distal tibial articular surface. The effectiveness of bedside pointofcare ultrasonography in the diagnosis and management of metacarpal fractures. Ankle fracture is one of the most common lower limb fractures for they account for 9% of all frac tures representing a significant portion of the trauma workload. Metatarsal shaft fractures are initially treated with a posterior splint and. Weber classification of ankle fractures radiology reference. Pdf ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the. Sex incidence sex n %age male 24 60 female 16 40 right side was involved in 25 62.
May be associated with a dislocation of the ankle joint. 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. Supervised exercise physio sessions to supervise and progress exercises, exercises for ankle and weightbearingbalance, gait training, advice, info leaflet. Diabetes mellitus is a common medical condition that is increasing in prevalence both closed and open management of ankle fractures in diabetics have higher complication rates solution. Brian dean, md, ms from the department of orthopaedic surgery, saint louis university, st.
A patients guide to ankle fractures introduction the ankle is the joint between the lower leg and the foot. The improved smallfragment implants and instruments, anatomic plates, and locking screw technology allow the effective treatment of the majority of ankle fracture patterns. Introduction ankle fractures are one of the most common lower limb fractures 1. You have sustained a fracture to your fibula outside ankle bone.
The ankle fracture management system was developed to be the most comprehensive set available for the treatment of common ankle fracture injuries. Surgical management of ankle fractures in patients with diabetes. As in all fractures through the articular surface of a major weightbearing joint, optimal treatment for fractures of the ankle follows the basic tenet. Displaced fractures are commonly treated with an open reduction and internal fixation. Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury.
Indications for operative treatment of ankle fractures are dictated by the stability of the ankle joint. This should optimise functional recovery and reduce the chance of development of posttraumatic arthritis. Often, the degree of pain, the inability to walk, or concern that a bone may be broken is what. A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months. Ankle fracture dislocations are generally lowenergy injuries most commonly seen in older adults. This can be achieved both conservatively and operatively. Hawarden d 2018 virtual fracture clinic in the management of foot and ankle fractures res rev nsights, 2018 doi. While a single case can be approached in a variety of ways, this book seeks to provide important guidelines which apply to most situations that may arise in foot and ankle injuries. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the talocrural joint.
Ankle fractures usually affect young men and older women, however, below the age of 50. Stabilitybased classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury harri pakarinen from the division of orthopedic and trauma surgery, department of surgery, oulu university hospital, university of oulu oulu, finland. Successful management of these injuries begins in the. Does a positive ankle stress test indicate the need for operative treatment. Surgical management of bimalleolar fractures of ankle. Management of ankle fractures rhode island medical society. Aug 23, 2014 biomechanical studies in an axially loaded ankle model indicate that despite fracture of the fibula and complete disruption of the anterior and posterior syndesmosis, in the absence of a medial side injury, the talus remains stable and centered in the mortise. A start with weightbearing xrays and then consider computed tomography or magnetic resonance imaging for complete evaluation of suspected injury to the lisfranc joint. Pdf management after failed treatment of ankle fracture. So do we change the indications and goals of treatment. Management fracture management stages include 4 rs. A fracture is a partial or complete break in a bone. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament. Stabilitybased classification for ankle fracture management.
Ankle fractures resident comprehensive fracture course 4192016 2 introduction ankle fractures are extremely common treated by a wide variety of surgeons complex injury not just interns case 4192016 3 introduction ankle fractures highenergy pilon fractures lowenergy pilon fractures atypical ankle fractures 4192016 4. Ankle fractures symptoms, diagnosis and treatment bmj. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 april 2015 v1s. This means that one or more of the bones that make up the ankle joint are broken. Ankle fractures are a common injury in children and adolescents 1 in children will sustain an ankle fracture each year. Ankle fractures are one of the most common lower limb. Contribution for management of metacarpal fractures. If the fracture is completely undisplaced with a congruent ankle mortise, the options are for either a shortleg nonweightbearing cast for 6 weeks, or open reduction and internal fixation. Conservative treatment with cast immobilisation is considered for. Laugehansen described a pronationdorsiflexion injury that producesan oblique medial malleolar fracture, a large anterior lip fracture, asupraarticular. Keeping these muscles strong can relieve foot and ankle pain and prevent further injury.
It will be of value to anyone providing care for foot and ankle injuries. Strengthening the muscles that support your lower leg, foot, and ankle will help keep your ankle joint stable. Virtual fracture clinic in the management of foot and ankle. Management after failed treatment of ankle fracture. Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4.