Ankle fracture: Difference between revisions

Revision as of 23:44, 24 March 2012

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

Type A (supination-adduction injury)
- Fibular Fx at or below the joint line without syndesmotic involvement
  - A1: isolated
  - A2: medial malleolus fx
  - A3: posteromedial fx
Type B (supination-external rotation injury)
- Fibular Fx at joint level w/ partial syndesmotic ligament injury
- B1: isolated
- B2: medial lesion (either malleolus or ligament)
- B3: medial lesion and fx of posterolateral tibia
Type C (pronation-eversion injury)
- Fibular Fx above joint level w/ complete syndesmotic disruption
  - C1: simple diaphyseal fibular fracture
  - C2: complex diaphyseal fibular fracture
  - C3: proximal fracture

Lateral malleolar Fx
1. Stable: >90% have good clinical result
  1. Treat like severe ankle sprain
2. Unstable: displacement >2mm, medial fx, or widening of medial clear space (deltoid injury)
Medial or posterior malleolar Fx
1. Must rule-out other injuries
2. If non-displaced, isolated:
  1. Short-leg posterior splint (ankle at 90')
  2. Non-weight bearing
  3. Refer in 5-7d
Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx
1. Short-leg posterior splint (ankle at 90o)
2. Immediate consultation in ED

Authors:

@@ Line 31: / Line 31: @@
 ## Stable: >90% have good clinical result
 ### Treat like severe ankle sprain
-## Unstable = displacement >2mm, medial fx, or medial ligament disruption
+## Unstable: displacement >2mm, medial fx, or widening of medial clear space (deltoid injury)
 #  Medial or posterior malleolar Fx
 ## Must rule-out other injuries