Ankle fractures

Ankle fractures by Dr Bipul Borthakur

1. ANKLE FRACTURES Dr B Borthakur (Professor) Dept of Orthopedics SMCH

2. Injuries around ankle commonly occurs from a slip while walking or fall or twisting during play or from a road traffic accidents. If not treated properly it may lead to disability or even deformity. Old age Bony injury young ligamentous and soft tissue components injuries

3. ANATOMY Ankle comprises of three bones tibia, fibula and talus. Talus articulates with the tibia plafond superiorly, posterior malleolus of the tibia posteriorly and medial malleolus medially. Lateral articulation is with malleolus of fibula.

4. Ligaments The joint is supported by: Fibrous capsule It surrounds the joint and is attached all around the articular margins Lateral ligament It consists of three bands Anterior-talofibular ligament Calcaneofibular ligament Posterior talofibular ligament

5. Deltoid or medial ligament This is a very strong triangular ligament present on the medial side of the ankle. Superficial layer Deep layer Tibiocalcaneal ligament * Anterior tibiotalar ligament Tibionavicular ligament * Posterior deep tibiotalar ligament Posterior superficial tibiotalar ligament Tibiospring ligament

6. Movement Dorsiflexion Tibialis anterior Accessory muscles: Extensor digitorum anterior longus Extensor hallucis longus Peroneus tertius Plantar flexion Gastrocnemius Soleus Accessory muscles: Plantaris Tibialis posterior Flexor hallucis longus Flexor digitorum longus

7. Syndesmosis maintains integrity between tibia and fibula resists axial, rotational, and translational forces

8. Mechanism of fracture Fall from height Twisting Direct trauma over ankle

9. Classification Weber Type A= Infrasyndesmotic Type B= Transsyndesmotic Type C= Suprasyndesmotic

10. Lauge -Hansen classification It is based on mechanism of injury.

11. Clinical presentation Swelling Pain and tenderness Restriction of movement Ecchymosis Deformity

12. Investigation Plain radiograph AP view Lateral view Mortise view

13. Fractures Isolated medial malleolus fracture

14. Isolated lateral malleolus fracture

15. Bimalleolar fracture

16. Posterior malleolus fracture

17. Treatment Non-operative Below knee cast Indications : Isolated nondisplaced medial or lateral malleolus fracture Isolated lateral malleolus fracture with <3mm displacement or no talar shift. Posterior malleolar fracture with <25% joint involvement or <2mm step-off.

18. Operative Indications: Talar displacement Displaced isloateral medial or lateral malleolus fracture Bimalleolar fracture Posterior malleolar fracture with >25% or >2mm step-off Open malleolar fracture Malleolar nonunion

19. Operative modalities Open reduction and internal fixation Plating Cancellous / Malleolar screws Tension band wiring

20. Medial malleolus fracture treated with Tension Band Wiring Medial malleolus fracture treated with malleolar screw

21. Lateral malleolus fracture treated with screw and neutralisation plate

22. Complication Infection Malunion Nonunion Post-operative stiffness Post-traumatic arthritis

23. THANK YOU