Pott’s fracture

ANKLE FRACTURES��
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.

1. ANKLE FRACTURES POTT’S FRACTURE

2. Introduction- Ankle joint is a modified hinge joint. The socket is formed by the distal articular surface of tibia and fibula, tibio -fibular lig and articular surfaces of the malleoli (mortise). Which articulates with the superior surface of talus. Ankle fractures include fractures of the medial and lateral malleoli as well as the distal articular surface of the tibia and fibula.

3. Anatomy-

4. Definition- A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli . Also known as Broken Ankle, Ankle Fracture and malleolar fracture. Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.

5. Mechanism of Injury- Twisting injury while walking,running . During certain activities such as landing from a jump,stress is placed on the tibia and fibula. Abduction, adduction or external rotation forces Sports involving sudden change of direction such as football, soccer, rugby, basketball and netball.

6. Classification- 1)Ankle fractures can be classsified as unimalleolar (70%) bimalleolar (23%) and trimalleolar fractures(7%) 2) Danis -Weber classification location and appearance of the fibular fracture 3) AO-OTA classification location of fracture lines & degree of comminution also describes the severity and degree of instability associated with fracture pattern 4) Lauge -Hansen classsification mechanism of injury

7. 1) Uni,bi and tri malleolar #’s

8. 2) Danis -Weber classification Type A - caused by internal rotation and adduction that produce a transverse fracture of the fibula at or below the plafond, with or without an oblique fracture of the medial malleolus

9. Type B - caused by external rotation that results in an oblique fracture of the fibula. The injury may include rupture or avulsion of the anteroinferior tibiofibular ligament, fracture of the medial malleolus , or rupture of the deltoid ligament.

10. Type C -fractures are abduction injuries with oblique fracture of the fibula proximal to the ankle joint, medial malleolar fracture or a deltoid ligament rupture.

11. 3) AO-OTA classification

12. 4) Lauge -Hansen classsification

13. Clinical features- Pain(sudden onset,sharp intense pain over lower leg/ankle) Swelling,bruising Crepitus Reduced ROM Inability to stand/ wt.bear Deformity

14. Diagnosis- H/O Twisting injury RTA Clinical features Radiological examination- Fracture line of med/lat malleolus Tibio -fibular syndesmosis -lateral subluxation of talus Posterior subluxation of talus

15. Orthopaedic Treatment- Basic principal of T/t is to achieve anatomical reconstruction of ankle-mortise so as to regain good function and minimise possibility of OA developing later. Expected time for bone healing- Extraarticular malleolar-6-10wks Itraarticular malleolar-8-12wks For stable injuries( undisplaced #)-below knee plaster cast is applied for 3-6weeks For unstable injuries(displaced#)-anatomical(closed) reduction and ORIF

16. ORIF Depending upon the type of fracture- Medial malleolus # Transverse#- compression screws,tension band wiring Oblique- compression screws Avulsion- tension band wiring Lateral malleolus # Transverse-TBW Spiral- Comp.screws Comminuted-buttress plating #lower end of fiblua - 4 hole plate

17. Post malleolus # Comp.screws Tibio -fibular Syndesmosis disruption- long screw from fibula into tibia. Conservative Method -Reduction by manipulation under GA-Once reduced below knee plaster cast 8-10wks(no wt bear)

18. Physiotherapy management- PT for conservatively managed fractures- First week- active MTP ROM’s Second week-MTP ROM’s with quadriceps strengthening exs By 4-6 weeks-cast may be changed to PTB cast-isometrics for quads, ankle strengthening exs (PF/DF) After 6-8 weeks, cast is removed,active /active assisted ROM’s for knee,ankle,subtalar and MTP, heel slides calf stretching, static quads and hams Isotonic and Isokinetic Exs for ankle also can be started. After 8-12 weeks self assisted passive ankle movts

19. Weight bearing- NWB with 2 pt. crutches By 6-8 weeks- PWB By 8 weeks-full wt bearing

20. Post-OP PT management- Phase 1 ( upto 6 weeks) Goals: PWB DF to neutral Control edema AROMs for ankle,subtalar and MT jts within pain tol . -Ankle pumps -Inv/ Evn -toe crunches Calf stretching,heel slides Elevation for edema Static quads and hams 2-4 weeks- initiate wt.bearing as tolerated with crutches followed by PWB

21. Phase2(6-8 weeks) Goals: FWB of involed LE >50%AROM all planes Control edema Minimize complications Maintain optimal bone and soft tissue healing AROMs PROMs in restricted range Heel slides Calf stretching Ankle isometrics grade 1-2 mobilization for ankle and subtalar jts . Leg curls,leg press Wall stretch with KF and KE FWB walking- minisquats , standing heel raise,one leg balance on floor, wobble board exs

22. Phase3(>8weeks) Goals: Full AROMs Restore gait on level surfaces,hills,stairs Full return to function Cont.Phase2 exs Prog.to theraband exs Squats and lunges also wobble board exs One leg standing with eyes open & eyes closed Stair climbing exs Agility training

23. REFERENCES Ebneizar Hoppenfield Maheshwari