The key role of the lateral malleolus in displaced fractures of the ankle. The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade. Weber b fracture of the lateral malleolus with concomitant. Metatarsal shaft fractures are initially treated with a posterior splint and. This normally takes approximately 6 weeks to unite heal although pain and swelling can be ongoing for 36 months. Intrmedullary versus extramedullary fixation of lateral. A medial malleolus fracture is a condition characterized by a break in the bony process situated at the inner aspect of the ankle known as the medial malleolus figure 1. Ankle fractures are among the most common fractures in adults, and the medial malleolus is often involved. Weight bearing on the injured ankle may be advised to be avoided and it should be protected while it is healing. Disp fx of lateral end of left clavicle, init for opn fx.
List the 3 common posterior malleolar fracture patterns. Conditions that can be related to lateral malleolus fracture include. The lateral malleolus is the name provided to the bone on the outside of the ankle joint. This article deals with the causes, symptoms, diagnosis, treatment and recovery time of medial malleolus fracture. A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. When the foot rolls out, this pulls tension on the medial malleolus, which can also cause a fracture. However, if dislocation is detected in xray, surgery is advised to realign and reposition the fracture together. Aug 14, 2019 an isolated fracture of the medial malleolus generally occurs when the foot is forcefully rolled inwards or outwards. Lateral malleolar fracture an overview sciencedirect. Reexamination on the ankle films there was no sign of an oblique fracture of the lateral malleolus, so we can exclude a weber b fracture. Pediatric ankle fractures orthopaedic trauma association. Enumerate the ways to ensure syndesmotic reduction. Introduction ankle fractures are injuries with an annual occurrence of approximately 100 100,000 person yearly 1 2 3. Ankle fracture update ota resident core curriculum lecture series updated november 2010 matt graves, m.
May 08, 2017 a medial malleolus fracture is a crack or break in the medial malleolus plural form. The only sign of injury on frontal projection is soft tissue swelling over the lateral malleolus. The verticallyoriented medial malleolus fracture supinationadductioninjuries,startsatthebendofthetibia andextendsinasuperiordirection. If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. Injuries to the deltoid ligament are estimated to occur in 10% to 36% of.
The most common type of ankle fracture is a lateral malleolus fracture, which can occur when the ankle is twisted or rolled. The bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural. Lateral malleolus fracture healing time, treatment, icd. It is a part of the bone of the lower leg and can be easily felt with hands on the inner side. A surgery may not be required if the ankle is still stable and no bone has been displaced. Oct 26, 2017 but a medial malleolus fracture is more often part of a compound injury involving one or both of the other ankle parts. Avulsion of ligament with bony fragment of lateral malleolus disorder 735844006, snomedct closed fracture of lateral malleolus disorder 34268009, snomedct fracture of lateral malleolus at syndesmosis disorder 735845007, snomedct fracture of lateral malleolus below syndesmosis disorder 735842005, snomedct open fracture of lateral malleolus disorder 4673003. A bone can fracture in different ways, causing complications or secondary conditions that your physician will look for. When is a simple fracture of the lateral malleolus not so simple.
Please see the picture below to understand where this injury is. In most cases of posterior malleolus fracture, the lateral malleolus fibula is also broken. Nov 28, 2019 the clear answer is that surgery is a worse option for stable lateral malleolus fractures. Management is determined by the location of the fracture and its effect on balance and weight bearing. Digital radiographic images of the left tarsus showing a displaced fracture of the lateral malleolus of the tibia large arrow, a nondisplaced fracture of the medial malleolus of the tibia, a bony defect in the lateral trochlear ridge of the talus and intraarticularbony. Ankle fracture, posterior malleolus fracture, trimalleolus fracture, posterolateral approach 1. Threedimensional computed tomography mapping of posterior. The most effective methods for assessing tibiotalar instability include stress and weightbearing radiographs.
The specimens were randomized to receive either a small onethird of the incisura, n 4 or a large twothirds of the incisura, n 5. The lower leg comprises of 2 long bones, known as the tibia and the fibula, which are situated beside each other figure 2. This bone is part of the fibula, one of two bones of the leg. Between 60 % and 70 % are unimalleolar fractures, the majority involving the lateral malleolus 5, 6. A lateral malleolus muhleeuhlus fracture is a type of broken ankle that happens when part of the fibula just above the ankle joint fractures. This action strains the sturdy medial deltoid ligament of the ankle, often tearing off the medial malleolus due to its strong attachment. It may also involve injury to a ligament of the leg. Medial malleolus vertically oriented fracture compression and buttress impaction fragments 22. Lateral malleolus fracture healing time, treatment, icd 9.
Among which about 7% to 44% are accompanied by posterior malleolus fracture, which are rarely seen alone 4 5. Studies have shown 3 that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities. This was supported by a number of posterior malleolus fracture lines extending to the medial malleolus. Malleolus definition of malleolus by medical dictionary. The more bones that are broken, generally the worse the injury. The reason is that nonsurgical treatment has been shown to be just as effective for the treatment of the broken bone. Drs amanatullah and wolinsky have no relevant financial. The medial malleolus is at particular risk for fracture in the patient who has sustained a previous fracture, and in whom the screws are still present and are in the path of the prosthesis. The key role of the lateral malleolus in displaced fractures. Jun 23, 2019 laugehansens classification, which was published in a issue of archives of surgery, has become one of the most widely used ankle. Medial malleolus fracture symptoms, treatment, causes.
In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. Fracture orientation not purely in coronal plane nearly always associated with the pull of the posterior tibfib ligament larger laterally than medially. Medial malleolus fracture fractured medial malleolus. Concerns risk for nonunion due to intraarticular nature of fracture risk for delayed union and late displacement rate of physeal arrest may be than the literature suggests abbott et al posna 2015 42 pediatric medial malleolus fractures with 3 months followup 52% developed a physeal bar.
When is a simple fracture of the lateral malleolus not so. Fracture of the lateral malleolus of the tibia in horses. Softtissue injury is common as the bones are subcutaneous. Ankle fractures are among the most common fractures treated by orthopaedic surgeons, with an incidence of approximately 187 fractures per 100,000 people each year. Jan 06, 2020 in addition, distribution analyses on posterior malleolus fracture lines indicated that the ser group tended to have higher linear density but more concentrated and orderly distribution fracture lines compared to the per group. Sometimes instead of pure rupture of the tibiofibular. Orthopedics drs amanatullah and wolinsky are from the department of orthopedic surgery, university of california at davis, california. The reason why late degenerative arthritis developed in some patients who had sustained displaced bimalleolar fractures of the ankle was investigated. Bimalleolar and bimalleolar equivalent fractures consist of either a fracture of the lateral and medial malleolus or a lateral malleolar fracture with complete disruption of the deltoid ligament figure 28. In the event that an individual suspects they may have lateral malleolus fracture, a radiographic evaluation xray will be essential to a proper diagnosis.
If the revision implant can be inserted with the screws left in, this is preferable, but if hardware removal is necessary, then multiple guide pins or k. Jan 20, 2016 the laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. More to know the bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural form of malleolus. Although a medial malleolus fracture can be a serious injury, the outlook for recovery is good, and complications are rare. If a fracture is diagnosed by imaging or gross deformity. The ankle fracture management system was developed to be the most comprehensive set available for the treatment of common ankle fracture injuries. A displaced ankle may require a surgical treatment for management. Management of isolated lateral malleolus fractures. There is also a possibility of a very proximal location of fibular fracture as high as the fibular neck. In addition, surgery has a chance of both infection and healing problems about 2 percent and these can cause significant problems.
This is because it shares ligament attachments with the posterior malleolus. Objective to characterize posterior malleolar fracture morphology using cole fracture mapping and to study reliability of quantification of 3dimensional computed tomography ctmodeling for posterior malleolar fractures with respect to quantification of fragment size in cubic millimeter and true articular involvement in square millimeter. An alternative fixation technique for small medial malleolus. The lateral malleolus is found at the foot end of the fibula, of a pyramidal form, and somewhat flattened from side to side. The fracture line is usually short spiral oblique and approximately 1 cm in length. Syndesmosis or medial malleolar injury not evident in this patient. Since you did hearfeel a popping in your ankle, there is a very good chance that to partially tore ligaments or did damage to the tendon that passes below the lateral malleolus. Lateral malleolus is the name given to the bone on the outside of the ankle joint, called the fibula. Isolated lateral malleolus fractures represent one of the most common injuries encountered by orthopaedic surgeons.
There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. Isolated fracture of the lateral malleolus requires no. The distal ridge of the lateral malleolus was removed with an osteotome and a 2. The improved smallfragment implants and instruments, anatomic plates, and locking screw technology allow the effective treatment of the majority of ankle fracture patterns. There can also be a fracture of the medial malleolus. Stage stage 3 more posterior displacement of the lateral malleolus fragment by the talus results in tension on the posterior syndesmosis with rupture or avulsion of the posterior. Surgical repair of fractures of the lateral and medial. Posterior malleolar fractures of the ankle article pdf available in european journal of trauma and emergency surgery 416 august 2015 with 5,614 reads how we measure reads. Posterior malleolus fractures occur in 744 % of ankle fractures 4, 5, 11, 18. This type of fracture is typically seen with patients who have had rotational forces acted on the leg or after landing from a forceful and impactful jump. Effect of posterior malleolus fracture on syndesmotic. The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood now. You have sustained a fracture to your medial malleolus bone on the inside of ankle.
It was designed to mimic the contours of the lateral malleolus and its medullary canal. Any violation of the dermis or constant bleeding regardless of size should raise concern of an open fracture. Symptoms fractures are acute injuries occur suddenly therefore symptoms can often be noticed immediately following injury. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and wellbeing around the world. The effect of minimally displaced posterior malleolar. Diagnosis ankle fractures usually result from torsional forces and present typically with tenderness, swelling, deformity and inability to weightbear. Fracture of the lateral malleolus is also occurred when the ankle is either twisted or rolled, usually with an awkward or uneven step. Now there is also the issue that perhaps you do not have a fracture at all as the only way to make a diagnosis of fracture is with an xray or some other imaging modality. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Displaced fracture of medial malleolus of unspecified tibia, initial encounter for closed fracture disp fx of medial malleolus of unsp tibia, init for clos fx icd10cm diagnosis code s82. Nevertheless, appropriate diagnosis and management of these injuries are not clearly understood. Uni malleolar fractures are the most common 68%, followed by bi malleolar fractures 25% and tri malleolar fractures 7%. These fractures are more common in women nearly 60 percent than men.
Here the fracture is seen only on lateral radiograph. The bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural form of malleolus. This trauma know as injury to the distal fibula of the ankle as well. Nonsurgical treatment may take up to 6 weeks of recovery time. Fracture orientation not purely in coronal plane nearly always associated with the pull of the.
Malleolus fracture an overview sciencedirect topics. Open reduction internal fixation of a bimalleolar ankle fracture 07. When the foot rolls inwards, this causes a compression of the medial malleolus on the inner side of the ankle. The acumed ankle plating system 3 is designed to provide a variety of fixation options for fractures of the distal tibia and fibula. A posterior malleolus fracture is a fracture of the back of the tibia at the level of the ankle joint. This case highlights the importance of orthogonal views. Potts fracture, also known as potts syndrome i and dupuytren fracture, is an archaic term loosely applied to a variety of bimalleolar ankle fractures.
If it is a typical inversion type of fracture, evidenced by an oblique fracture line extending proximally toward the tibial shaft, the main blood supply to the. This usually occurs in association with a traumatic force such as a rolled ankle or a direct blow and causes a sudden onset of intense pain in the area. Bimalleolar fracture lateral malleolus fracture medial malleolus fracture posterior malleolus. The clear answer is that surgery is a worse option for stable lateral malleolus fractures. A 23 cm longitudinal incision was made over the distal fibula. The laugehansen classification is a system of categorizing ankle fractures based on the foot position and the force applied. Posterior malleolus fracture repair utilizing a variable angle locking plate. Medial malleolus fracture east sussex healthcare nhs trust. The injury is caused by a combined abduction external rotation from an eversion force. Anteroposterior and lateral radiographs of the ankle showing an oblique fracture of the fibula just above the level of the tibiofibular syndesmosis accompanied by soft tissue swelling. Shawn f kane md, in the sports medicine resource manual, 2008. However, beware the nondisplaced ankle fracture presenting postinjury with minimal swelling and no deformity. Medial malleolus fracture and broken ankle treatment.
Fragment size hard to determine on lateral view reason. Ankle lateral malleolus avulsion fracture with os subfibulare. It would usually take around 6 weeks for the ankle to heal 4, 6. Small bone fragment at the inferior portion of the lateral malleolus is consistent with an avulsed fracture. State the indication to fix posterior malleolar fractures. A model of stageiv supinationexternal rotation injury was created in 9 throughtheknee cadaveric specimens. A lateral malleolus fracture is an injury involving a complete break in the boney prominence located at the outer aspect of the ankle i. Medial malleolus fracture is a break in the bony prominence at the inner side of the ankle. Clinical examination findings are important but less reliable. Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral malleolus following a.
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