![]() Non-operative treatment of unstable ankle fractures is associated with a non-union rate of between 48 and 73% compared to 0 and 19% after operative treatment. In potentially unstable fractures treated non-operatively with cast application, it may be necessary to follow the patient weekly with serial x-rays to assess the position of the fracture, with cast removal at approximately 6 weeks depending on clinical and radiographic evidence of healing. This requires a detailed discussion with the patients and a shared decision-making. Patients were offered a choice of a weight bearing below knee cast a functional ankle brace or a regime of rest, ice, compression bandage and elevation. They reviewed 163 patients with stable ankle fractures over a period of 8 years. Hutchinson and Barrie suggested that the majority of ankle fractures seen in clinic are stable, are not likely to displace and do not require plaster casting to achieve union in a good position. Non-operative management includes immobilisation with plaster cast or boot, either weight-bearing or non-weight-bearing, for 6 weeks or functional management with controlled range of motion and combinations of non-weightbearing or weight-bearing may also be considered. The choice of conservative or surgical management depends on the question, whether the fracture is ‘stable’ or ‘unstable’. Management of ankle fractures depends on accurate determination of the nature and severity of the injury. In addition to standard plain radiographs, CT scan may be useful in highly comminuted fractures for mapping out fracture anatomy and preoperative planning. The fibular fracture may require a bridging technique or a nail. The fracture is proximal to the plafond, and may be as high as fibular neck (Maisonneuve) with associated syndesmotic injury.Ĭomminuted fracture of fibula above ankle mortise with medial malleolar fracture or deltoid injury. Pronation-external rotation (PER) - (Weber C) The SER IV fracture has a medial component: either a medial malleolar fracture or a deltoid rupture. (Weber B) The SER fracture type II, has no medial injury, mechanically stable and do not require surgery. Transverse fracture of the lateral malleolus inferior to the ankle joint with classically vertical fracture of the medial malleolus. This is based on, firstly the position of the foot at the time of injury, and secondly the deforming force on the ankle. Can be associated with transverse avulsion medial malleolus fracture or deltoid ligament rupture When accompanied by medial malleolus fracture or with deltoid ligament rupture the ankle is considered unstable.Ĭ - Fractures above the joint line, generally with syndesmotic injury. Avulsion injuries associated frequently with oblique or vertical medial malleolar fracturesī - Fracture begins at joint level and extends proximally in an oblique fashion. Following stabilization of the lower leg, a supination/external rotation force is then applied to the ankle.The most common cause is a low-energy fall (38%-80%), followed by inversion injuries (31.5%), sporting injuries (10.2%), fall from stairs (around 8%), fall from a height (4.5%), and motor vehicle accident (4.2%).Ī - Fracture below the syndesmosis. ![]() A mechanical stress view is performed with the patient supine/sitting upright with the lower leg in 15-20° internal rotation.A “ stress” view of the ankle joint can assist in identifying injury to the deep deltoid ligament with associated ankle joint instability.Ankle radiographs can appear “normal” (may only have an occult deep deltoid ligament injury with minimal medial clear space widening and/or isolated posterior tubercle disruption).In addition to imaging of the ankle, tib-fib x-rays should also be obtained to evaluate the entire length of tibia/fibula.Weakness of ankle dorsiflexion/subtalar joint (foot) eversion and/or numbness along the lateral lower leg/dorsum of the foot should raise clinical suspicion for a Maisonneuve injury. The common peroneal nerve courses over fibular head, thus a meticulous neurologic exam is critical.“SQUEEZE” test: compression of the tibia/fibula elicits pain in the ankle/lower leg.
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