Diferencia entre revisiones de «Ankle fracture»
(Created page with "==Classification== Danis-Weber system: type A-fibular Fx at or below the joint line without syndesmotic involvement. type B-fib Fx at joint level with partial syndesmotic lig...") |
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==Malleolar Fractures== | |||
* Isolated Malleolar | |||
* Stable if displaced <2mm, joint surface involvement <25%, and no contralateral or syndesmotic injury | |||
* Medial Malleolus Fx | |||
* Is it really isolated? (frequently associated with lateral or posterior injuries) | |||
* Posterior Malleolus Fx | |||
* Usually occurs in association w/ post. tibiofibular ligament injury / fibular fx | |||
* Rarely occurs in isolation! | |||
* Bimalleolar | |||
* Lateral + medial malleoli fx | |||
* Unstable | |||
* Trimalleolar | |||
* Lateral + medial + posterior malleoli fx | |||
* Requires surgical stabilization | |||
== == | |||
==Imaging== | |||
* Ottawa Ankle Rules | |||
* 3 views: | |||
* AP - Best for isolated lateral and medial malleolar fractures | |||
* Oblique (mortise) - Best for evaluating for unstable fracture or soft tissue injury | |||
* at a point 1cm proximal to the articular surface of the tibia the space between the tib/fib should be ≤6cm | |||
* Lateral - Best for posterior malleolar fractures | |||
==Classification== | ==Classification== | ||
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C-surgery usually required. | C-surgery usually required. | ||
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* Emergent | |||
* Open fracture | |||
* Fx/dislocation with vascular compromise | |||
* Fx/dislocation with significant tenting of the skin | |||
Recommended (pt often admitted for repair) | * Recommended (pt often admitted for repair) | ||
* Tillaux/triplane fractures | |||
Recommended (phone is ok) | * Intrarticular fractures with displacement | ||
* Pilon fractures (reduce if ortho unavailable) | |||
* Trimalleolar fractures | |||
* Maisonneuve Fx | |||
* Any Fx with significant disruption of mortise | |||
* Recommended (phone is ok) | |||
* Bimalleolar Fx | |||
* Minimally displaced medial or lateral malleolar Fx | |||
== | ==Management== | ||
* Lateral malleolar Fx | |||
* Stable - >90% have good clinical result | |||
* Treat like severe ankle sprain | |||
* Unstable = displacement >2mm, medial fx, or medial ligament disruption | |||
* Medial tenderness indicates need for stress xrays to determine degree of instability | |||
* Medial or posterior malleolar Fx | |||
* Must confirm no other injuries! | |||
* If non-displaced, isolated: | |||
* Short-leg posterior splint (ankle at 90o) | |||
* Non-weight bearing | |||
* Refer in 5-7 days | |||
* Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx | |||
* Short-leg posterior splint (ankle at 90o) | |||
* Refer within few days for surgical intervention | |||
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* Nerve damage | |||
* Peroneal nerve (lateral ankle injury) | |||
* Weak foot dorsiflexion | |||
* Tibial nerve (medial ankle injury) | |||
* Compartment syndrome | |||
* Nonunion or malunion | |||
* Fracture blister/skin necrosis | |||
== == | == == | ||
Revisión del 23:38 1 mar 2011
Malleolar Fractures
- Isolated Malleolar
- Stable if displaced <2mm, joint surface involvement <25%, and no contralateral or syndesmotic injury
- Medial Malleolus Fx
- Is it really isolated? (frequently associated with lateral or posterior injuries)
- Posterior Malleolus Fx
- Usually occurs in association w/ post. tibiofibular ligament injury / fibular fx
- Rarely occurs in isolation!
- Bimalleolar
- Lateral + medial malleoli fx
- Unstable
- Trimalleolar
- Lateral + medial + posterior malleoli fx
- Requires surgical stabilization
Imaging
- Ottawa Ankle Rules
- 3 views:
- AP - Best for isolated lateral and medial malleolar fractures
- Oblique (mortise) - Best for evaluating for unstable fracture or soft tissue injury
- at a point 1cm proximal to the articular surface of the tibia the space between the tib/fib should be ≤6cm
- Lateral - Best for posterior malleolar fractures
Classification
Danis-Weber system:
type A-fibular Fx at or below the joint line without syndesmotic involvement.
type B-fib Fx at joint level with partial syndesmotic ligament injury.
type C-fibular Fx above the joint level and complete syndesmotic disruption.
C-diaphyseal (Dupuytren Fx) or proximal fibular Fx (maissoneuve).
fracture types:
lateral malleolar-Tx depends on type A, B, or C
A-splinting in ED, 6-8 weeks in cast.NWB for three weeks.
B-often requires a surgical repair.
C-surgery usually required.
Disposition
- Emergent
- Open fracture
- Fx/dislocation with vascular compromise
- Fx/dislocation with significant tenting of the skin
- Recommended (pt often admitted for repair)
- Tillaux/triplane fractures
- Intrarticular fractures with displacement
- Pilon fractures (reduce if ortho unavailable)
- Trimalleolar fractures
- Maisonneuve Fx
- Any Fx with significant disruption of mortise
- Recommended (phone is ok)
- Bimalleolar Fx
- Minimally displaced medial or lateral malleolar Fx
Management
- Lateral malleolar Fx
- Stable - >90% have good clinical result
- Treat like severe ankle sprain
- Unstable = displacement >2mm, medial fx, or medial ligament disruption
- Medial tenderness indicates need for stress xrays to determine degree of instability
- Medial or posterior malleolar Fx
- Must confirm no other injuries!
- If non-displaced, isolated:
- Short-leg posterior splint (ankle at 90o)
- Non-weight bearing
- Refer in 5-7 days
- Lateral malleolar fx with deltoid injury OR bimalleolar OR trimalleolar fx
- Short-leg posterior splint (ankle at 90o)
- Refer within few days for surgical intervention
Complications
- Nerve damage
- Peroneal nerve (lateral ankle injury)
- Weak foot dorsiflexion
- Tibial nerve (medial ankle injury)
- Compartment syndrome
- Nonunion or malunion
- Fracture blister/skin necrosis
See Also
Ortho: Maisonneuve
Ortho: Pilon Fx
Ortho: Ankle (Ottowa)
Ortho: Ankle (Sprain)