Ankle fracture: Difference between revisions
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*Always palpate proximal leg to rule-out [[Maisonneuve Fracture]] | *Always palpate proximal leg to rule-out [[Maisonneuve Fracture]] | ||
==Imaging== | |||
*[[Ottawa Ankle Rules]] | |||
*3 views: | |||
**AP - Best for isolated lateral and medial malleolar fractures | |||
**Oblique (mortise) - Best for evaluating for unstable fracture or soft tissue injury | |||
***At a point 1cm proximal to articular surface of tibia the space between the tib/fib should be ≤6cm | |||
**Lateral - Best for posterior malleolar fractures | |||
==Classification (Danis-Weber System)== | |||
*Type A | *Type A | ||
**Fibular Fx at or below the joint line without syndesmotic involvement | **Fibular Fx at or below the joint line without syndesmotic involvement | ||
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**Pronation-eversion injury | **Pronation-eversion injury | ||
== | ==Management== | ||
# Lateral malleolar Fx | # Lateral malleolar Fx | ||
## Stable - >90% have good clinical result | ## Stable - >90% have good clinical result | ||
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### Medial tenderness indicates need for stress xrays to determine degree of instability | ### Medial tenderness indicates need for stress xrays to determine degree of instability | ||
# Medial or posterior malleolar Fx | # Medial or posterior malleolar Fx | ||
## Must | ## Must rule-out other injuries | ||
## If non-displaced, isolated: | ## If non-displaced, isolated: | ||
### Short-leg posterior splint (ankle at | ### Short-leg posterior splint (ankle at 90') | ||
### Non-weight bearing | ### Non-weight bearing | ||
### Refer in 5- | ### Refer in 5-7d | ||
# Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx | #Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx | ||
## Short-leg posterior splint (ankle at 90o) | ##Short-leg posterior splint (ankle at 90o) | ||
## Refer within few days for surgical intervention | ##Refer within few days for surgical intervention | ||
==See Also== | ==See Also== | ||
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*[[Maisonneuve Fracture]] | *[[Maisonneuve Fracture]] | ||
*[[Pilon Fracture]] | *[[Pilon Fracture]] | ||
==Source== | |||
*Tintinalli | |||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 22:44, 16 February 2012
Background
- Always palpate proximal leg to rule-out Maisonneuve Fracture
Imaging
- Ottawa Ankle Rules
- 3 views:
- AP - Best for isolated lateral and medial malleolar fractures
- Oblique (mortise) - Best for evaluating for unstable fracture or soft tissue injury
- At a point 1cm proximal to articular surface of tibia the space between the tib/fib should be ≤6cm
- Lateral - Best for posterior malleolar fractures
Classification (Danis-Weber System)
- Type A
- Fibular Fx at or below the joint line without syndesmotic involvement
- Supination-adduction injury
- Type B
- Fibular Fx at joint level w/ partial syndesmotic ligament injury
- Supination-external rotation injury
- Type C
- Fibular Fx above joint level w/ complete syndesmotic disruption
- Pronation-eversion injury
Management
- Lateral malleolar Fx
- Stable - >90% have good clinical result
- Treat like severe ankle sprain
- Unstable = displacement >2mm, medial fx, or medial ligament disruption
- Medial tenderness indicates need for stress xrays to determine degree of instability
- Stable - >90% have good clinical result
- Medial or posterior malleolar Fx
- Must rule-out other injuries
- If non-displaced, isolated:
- Short-leg posterior splint (ankle at 90')
- Non-weight bearing
- Refer in 5-7d
- Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx
- Short-leg posterior splint (ankle at 90o)
- Refer within few days for surgical intervention
See Also
Source
- Tintinalli