ankle fracture

1. Sarawut Watt.
Extern
Conference

2. ผู้ป่วยชายไทยคู่ อายุ41ปี
ภูมิลาเนา อ.ด่านขุนทด จ.นครราชสีมา
CC : ปวดข้อเท้าขวา 6 ชั่วโมงก่อนมาโรงพยาบาล
PI : 6ชั่วโมงก่อนมาโรงพยาบาล ขับมอเตอร์ไซค์หลบสุนัข เกิดล้ม ขาขวา
กระแทกพื้น มีอาการปวดเท้าขวาขึ้นมาทันที ข้อเท้าขวาบวม ขยับไม่ได้
เพราะเจ็บ ไม่มีชา จึงมาโรงพยาบาล
Case Scenerio

3. A Thai man, Good consciousness
Vital Signs stable, Afebrile
HEENT : not pale, no jaundice
Heart : normal S1, S2, no murmur
Lungs : Clear and equal BS both lungs
Abdomen : soft, not tender
Physical Examination

4. Ext : Affected Part
Rt. Foot :
- abrasion wound 1*3 cm. at medial side of foot,
- tender at lateral Malleolus and below medial
malleolus,
- Limit ROM due to pain ,
- normal pinprick sensation,
- Dorsalis pedis & post. Tibial artery can palpable 2+

6. Film Right Ankle AP , Lateral View

7. Film Right Ankle mortise view

8. Closed fracture of right distal fibular
(closed fracture right lateral malleolus)
Diagnosis at ER

9. - On Right Posterior Short leg slab
- Follow up 2 weeks
+ film Right ankle AP, lateral, Mortise view
- Advice : Non weight bearing with crutches
Home Medication
- Paracetamol(500) 1tab po prn q 6hr
- Tramol(50) 1*3 po pc
Management at ER

10. Right Bimalleolar Fracture
Definite Diagnosis

11. Ankle
Fracture

12. Three bones make up the ankle joint
 Tibia - shinbone
 Fibula - smaller bone of the lower leg
 Talus - a small bone that sits between the heel
bone (calcaneus) and the tibia and fibula
Anatomy

14. Anatomy

15. Twisting or rotating your ankle
Rolling your ankle
Tripping or falling
Impact during a car accident
Causes

16. Immediate and severe pain
Swelling
Bruising
Tender to touch
Cannot put any weight on the injured foot
Deformity ("out of place")
Symptoms

17. The Ottawa ankle rules
 the need for plain films in patients with ankle injury.
Patients should have a plain film,
if there is malleolar tenderness and at least one of the
following
 tenderness along the posterior surface of the distal fibula
 tenderness along the posterior surface of the distal tibia
 inability to weightbear after the trauma and when being
assessed
Diagnosis

18. Ottawa Ankle rules

19. - AP view
- Lateral view
- Mortise view (Internal rotation 10 degree)
Plain film of Ankle

20. AP View
 TibioFibular Overlap
<10mm implies Syndesmosis injury
 TibioFibular Clear space
>5mm implies Syndesmosis injury
 Talar Tilt
>2mm is considered abnormal
Radiographic Measurement

21. Lateral View
 Posterior malleolus fracture
 Subluxation of the talus
 Angulation of distal fibula
 Talus fracture
 Calcaneus fracture

22. Mortise View
Abnormal findings
• TibioFibular overlap < 1mm
• Medial Joint space widening

23. Classification of distal fibula fractures
split fractures into groups by severity
Weber classification
Weber A: below the syndesmosis (stable)
Weber B: at the syndesmosis (may be unstable)
Weber C: above the syndesmosis (unstable)
Classification

24. Weber Classification

25. Nonoperative
short-leg walking cast/boot
indications
isolated nondisplaced medial malleolus fracture
or tip avulsions
 isolated lateral malleolus fracture with < 3mm
displacement and no talar shift
 posterior malleolar fracture with < 25% joint
involvement or < 2mm step-off
Treatment

26. Operative
open reduction internal fixation
indications
 any talar displacement
 displaced isolated medial or Lateral malleolar fracture
 bimalleolar fracture and bimalleolar-equivalent
fracture
 posterior malleolar fracture with > 25%
or > 2mm step-off
 open fractures

27. Wound problems
Deep infections
Post-traumatic arthritis
Complications