Ankle fractures: Understanding the mechanism of injury is the key to analyzing the radiographs

1998 ◽  
Vol 5 (1) ◽  
pp. 49-60 ◽  
Author(s):  
Anthony J. Wilson
Keyword(s):  
Ankle Fractures ◽  
Mechanism Of Injury

scholarly journals Findings of Routine Diagnostic Ankle Arthroscopy for Management of AO 44-C Fibular Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Dean ◽  
Francis McGuigan ◽  
Nicholas Casscells
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Loose Bodies ◽  
Therapeutic Benefits ◽  
Articular Damage

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: High fibula fractures, including Maisonneuve and Weber type C fractures are commonly associated with syndesmotic injuries resulting in subluxation and dislocation of the ankle. These injuries to the joint are rarely evaluated or addressed during operative fixation, which generally consists of open reduction internal fixation of the fibula with or without fixation of the syndesmosis. Chondral lesions and loose bodies in ankle fractures may predict a poor result and can be addressed using arthroscopy to avoid exacerbating articular damage. The purpose of this study is to identify the frequency and severity of articular pathology in Weber C and Maisonneuve fibula fractures. Methods: A single surgeon case series of operatively managed ankle fractures with arthroscopic assessment from 2011-2015 was retrospectively reviewed. Inclusion criteria were patients with AO 44-C ankle fractures who were aged >17 and underwent arthroscopic assessment of the ankle joint prior to open reduction and internal fixation. Patients were excluded from the series if they presented <2 weeks from the time of injury, had a pilon variant, or had incomplete medical records available. Demographic information on the patients including age, sex, and BMI were collected. Information on mechanism of injury was recorded. Operative reports were reviewed and the presence of chondral injury and loose bodies was recorded. Descriptive statistics were performed on the collected data. Results: 18 patients (12 male, 6 female) with a mean age of 38.3 years (range 17-61; SD 13.9) were included in the case series. The average BMI 29.6 (SD 6.92). Five of the included fractures were Maisonneuve fractures while the remaining 13 were Weber C ankle fractures. The mechanism of injury of the fracture was low energy in 12, high energy in 1, and unknown in 5. On arthroscopic examination, 12 (66.7%) of the fractures were associated with full thickness articular cartilage injury requiring formal chondroplasty, 16 (88.9%) were associated with a minimum of partial articular damage, and only 2 (11.1%) had no articular damage identified on arthroscopy. Additionally, 12 (66.7%) had loose bodies that were removed during ankle arthroscopy. Conclusion: This study adds to a growing collection of literature concerning chondral injuries during ankle fractures. The data from this study suggest that AO 44-C fibular fractures are associated with a high rate of intraarticular pathology that can be effectively identified and managed during arthroscopy. Prospective studies are required to determine if there are therapeutic benefits to routine ankle arthroscopy in AO 44-C ankle fractures.

317 Audit of The Management of Ankle Fractures in The Emergency Department of Leighton Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Ugwu ◽  
R Lowsby
Keyword(s):  
Emergency Department ◽  
Compliance Rate ◽  
Clinical Findings ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Effective Management ◽  
British Orthopaedic Association

Abstract Background Ankle fractures are common presentations in the emergency department. The aim of treatment is to provide stability and restore alignment of the joint to as close as possible to the pre – injury state. The British Orthopaedic Association Audits Standards for Trauma (BOAST) guidelines provide clear recommendations for effective management of ankle fractures. Specific aspects of this guidelines that could be objectively assessed were selected for this audit to check if practices in the emergency department were meeting the national recommendations. Method Data was collected retrospectively. All patients with closed ankle fractures seen in the emergency department between 01/08/2020 and 31/08/2020 were included. Patients’ emergency department notes as well as electronic radiographic records were reviewed and analysed. Results There was 100% compliance rate for 3 of the domains assessed which include: clear documentations of mechanism of injury and clinical findings; documentation of co-morbidities of patients that can influence treatment and urgent performance of radiographs in clinically deformed ankles before manipulation.There was 75% compliance in performing and documentation of radiographs before transfer from the emergency. The worst domain was the re-assessment and documentation of neurovascular status post manipulation with only one reviewer out of five assessed documenting clearly after the process was completed. Conclusions Posters circulated in the department highlighting the findings of the audit. Furthermore, the LocSSIPs for reduction of ankle fractures was edited to include re-assessment of neurovascular status post manipulation.

Ankle Trauma

2019 ◽  
pp. 108-112
Author(s):  
Pavan Parasu ◽  
Winnie A. Mar
Keyword(s):  
Treatment Options ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Mechanism Of Injury ◽  
Tibial Pilon ◽  
Imaging Characteristics ◽  
Fibular Fracture ◽  
Ankle Trauma ◽  
Imaging Strategy

Chapter 23 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics and classification and treatment options of ankle fractures. The Lauge-Hansen and Weber classifications for malleolar fractures are described. The Lauge-Hansen classification of ankle fractures is based on the mechanism of injury. Weber classification of ankle fractures is based on the fibular fracture location relative to the ankle mortise. Pilon, Maisonneuve, and osteochondral fractures are also discussed. Ankle injuries are first evaluated with radiographs. CT examination is helpful in preoperative planning for distal tibial Pilon fractures, which are generally underestimated radiographically. MRI may be useful in determining associated ligamentous injury.

scholarly journals The frequency of proximal tibiofibular joint types in patients with malleolar fractures

2018 ◽  
Vol 17 (4) ◽  
pp. 625-630
Author(s):  
Salman Ghaffari ◽  
Masoud Shayesteh Azar ◽  
Mohammad Hossein Kariminasab ◽  
Tahereh Ranjbar ◽  
Bahman Ghaffari
Keyword(s):  
Normal Population ◽  
Adult Patients ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Common Mechanism ◽  
Proximal Tibiofibular Joint ◽  
Mechanism Of Injury ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Tibiofibular Joint

Background: Due to the prevalence of ankle malleolar fractures and by considering the influence of proximal tibiofibular joint(PTFJ) on fibula movement during ankle motion and subsequently on ankle injuries, this research was conducted to determine distributed frequency of the PTFJ in adult patients with malleolar fractures.Methods: This survey was conducted on a prospective cross-sectional basis. adult patients with malleolar fractures in two year period enrolled . Information, such as gender, age, mechanisms of fractures, reason of fractures, location of fractures was Collected, classified and reported along with descriptive statistics. Frequency of PTFJ in normal population determined and used for comparison with study group.Results: In the 79 patients could match our criteria in this study. The age of patients was 37±15 with range of 18-80 years. The highest number of ankle fractures were seen in third decade of age and these fractures were more prevalent in men. The most common cause of ankle fractures was traffic accidents (54/43%).the most common injury was lateral malleolar fracture (68/74%) and the most common mechanism of injury was Lauge-Hansen supination – external rotation, Danis-Weber type B . Frequency of PTFJ transverse and oblique types in normal population (80.6/19.4%)and study(71/29%) groups was statistically different (P < 0/05). According to mechanism of injury and location of fibular fracture, there was no significant difference between PTFJ types (P > 0/05).Conclusions: Frequency of oblique PTFJ in patients with malleolar fracture was more than normal population. There was no correlation between PTFJ type and mechanism of malleolar fracture or location of fibular fracture.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.625-630

scholarly journals Are Locked Plates Necessary to Maintain Reduction in the Treatment of Geriatric Ankle Fractures?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Aseel G. Dib ◽  
Caitlin Curtis Crocker ◽  
John C. Prather ◽  
Michael D. Johnson
Keyword(s):  
Bone Quality ◽  
High Energy ◽  
Fracture Pattern ◽  
Ankle Fractures ◽  
Locking Plates ◽  
Mechanism Of Injury ◽  
Trimalleolar Fractures ◽  
Loss Of Reduction ◽  
Geriatric Fractures

Category: Ankle; Trauma Introduction/Purpose: Treatment of geriatric fractures are unique in their perioperative and postsurgical complications. Increased age, increased number of comorbidities, and decreased bone quality present a significant challenge when treating geriatric fractures, including ankle fractures. Recent studies have hypothesized using locking plates will lead to better outcomes compared to non-locking plates in geriatric ankle fractures. Conventional non-locking plates depend on the bone quality and screw-plate friction in order to achieve proper fixation and stability whereas locking plates do not. Locking plates are common in this patient population due to greater rigidity and biomechanical stability while not relying on bone quality to maintain fixation. This study aims to determine if locking plates are necessary to maintain reduction in geriatric ankle fractures. Methods: After approval from the Institutional Review Board, a retrospective chart review was performed on all patients 60 years or older sustaining an ankle fracture between 2012-2018. Patients with less than 3 months follow-up at the time of injury were excluded. Each patient underwent surgical fixation at the discretion of the attending surgeon for bimalleolar or trimalleolar ankle fractures. The following patient information was collected from the charts: age, mechanism of injury, and comorbidities. Radiographic review was performed to determine open or closed fracture status, the type of fracture pattern and presence or absence of a syndesmotic injury. Patient radiographs from the most recent follow-up were analyzed for maintenance of reduction and use of a locking or non-locking plate. Statistical analysis was performed using the Chi Square Test for significance and the Fisher’s Exact Test when necessary. Results: Out of 218 patients, 143 received locking plates (L) and 75 received non-locking plates (NL). There were 99 bimalleolar fractures (69.2%) and 44 trimalleolar fractures (30.8%) in the L group. The NL group had a higher percentage of trimalleolar fractures, 50.7% (38), with 37 bimalleolar fractures (49.3%) (p=0.004). The two groups did not differ in terms of mechanism of injury (p=0.906), high energy (39.2% in L and 41.3% in NL, p=0.773), and open fractures (24.5% in L and 17.3% in NL, p=0.227). Upon radiographic review, 142 patients in the L group (0.7%) and 72 patients in the NL group (4.0%) maintained reduction (p=0.119). Loss of reduction in the L group was a trimalleolar fracture whereas 2 bimalleolar and 1 trimalleolar fractures in the NL group. Conclusion: Our study demonstrates that there is not a greater loss of reduction when utilizing locking plates. Surgeons should keep this in mind when choosing constructs for fixation of geriatric ankle fractures.

Correlation of AO and Lauge-Hansen Classification Systems for Ankle Fractures to the Mechanism of Injury

2013 ◽  
Vol 34 (11) ◽  
pp. 1516-1520 ◽  
Author(s):  
Edward K. Rodriguez ◽  
John Y. Kwon ◽  
Lindsay M. Herder ◽  
Paul T. Appleton
Keyword(s):  
Classification Systems ◽  
Ankle Fractures ◽  
Mechanism Of Injury

scholarly journals P109 Sherlock Holmes in Clinical Practice: The Deduction of the Pattern and Mechanism of Injury in Ankle Fractures Using Lauge-Hansen System

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Fang Fang Quek ◽  
Fang Fang Quek
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
External Rotation ◽  
Ankle Fractures ◽  
X Rays ◽  
Mechanism Of Injury ◽  
Proximal Fibula ◽  
Maisonneuve Fracture ◽  
Fibular Fracture ◽  
The Right

Abstract Introduction Ankle fractures are among the commonest fractures in adults and as population ages, the incidence is also increasing. It is crucial to ascertain the mechanism of injury of an ankle fracture as it determines the management plan. The diagnosis and management of ankle fractures are usually relatively straightforward but they are not always the case. Most patients are unable to recall the exact mechanism of injury due to the instantaneous nature of incident. We herein describe a case report of a patient who sustained an ankle fracture following a fall but was unable to recall the exact mechanisms of injury. This case report addresses the importance of recognising Maisonneuve fractures and how Lauge-Hansen Classification system might be useful in diagnosing and making management plans for ankle fractures. Case Report A 30-year-old male self-presented to the Emergency Department in a wheelchair following a fall. He tripped down the last four steps of stairs the night before, sustaining a right ankle injury as a result. He has been unable to weight-bear since. Elevation and application of ice packs have showed limited effect. Patient was unable to recall the exact mechanism of injury. On examination, the right ankle was swollen and there were bruises around the medial malleolus. Upon palpation, he complained of bony tenderness around lateral and medial malleoli. No other injury was found and patient was neurovascularly intact. A referral was made to the Orthopaedics team and further orthopaedic examinations revealed tenderness and crepitus upon palpation over the proximal fibula. Full lower leg X-rays was ordered to look for possible proximal fibula fracture. A diagnosis of closed, Maisonneuve (Weber C)/trimalleolar fracture of the right ankle was made. A CT-scan of the right ankle was requested to determine the involvement of joint surface to aid surgical planning. Both CT-scan and ankle X-rays showed disrupted syndesmosis. Disrupted syndesmosis is most commonly associated with Weber C fractures as shown in this case. Since the fibular fracture is greater than 4.5cm away from the tibial plafond, syndesmosis fixation is required. In Maisonneuve fractures, syndesmotic screws can be used to achieve anatomical reduction and ankle stability. This patient was scheduled for an ORIF surgery. Discussions Based on the findings of medial and posterior malleoli fractures from the ankle X-rays, we can deduce that the patient has most likely sustained a complete Pronation-External Rotation (PER) injury. A Maisonneuve fracture was almost missed initially due to distracting injuries and not obtaining full lower leg X-rays. However, based on Lauge-Hansen Classification, we know that it is highly unlikely to have a posterior malleolus fracture (Stage 4) without any fibular fracture (Stage 3). Hence, a full-fibula X-ray was ordered to look for proximal fibula fracture and the X-rays revealed a spiral fracture at the proximal fibula (Maisonneuve fracture). The injury force was transmitted along the interosseous membrane and exited at the shaft of proximal fibula, causing a proximal fibular fracture. PER or injury sustained from an internally rotated leg on a planted foot may cause external rotation injury, resulting in a disruption of the ligaments. The syndesmosis, which provides primary support to the ankle, if disrupted, will disrupt the ankle mortise, displacing the fibula laterally, as demonstrated in this case. Conclusion As demonstrated in this case, some fractures, like the Maisonneuve fracture, can easily be missed. Due to distracting injuries, the chief complain in most cases of Maisonneuve fracture is severe ankle pain instead of the fracture site at proximal fibula. These fractures, if not identified early, can lead to poor prognosis. It is important to consider Maisonneuve fracture in all ankle injuries. A delayed diagnosis can lead to post-traumatic arthritis and pain, leading to loss of function. This case report addresses the importance of recognising easily missed fractures and how Lauge- Hansen Classification system is useful in aiding the diagnosis and management of ankle fracture

Projection of Patient Condition Code Distributions Based on Mechanism of Injury

2003 ◽  
Author(s):  
James M. Zouris ◽  
G. Jay Walker ◽  
Christopher G. Blood
Keyword(s):  
Mechanism Of Injury

Symptom Complaints Following Blast Versus Nonblast Mild TBI: Does Mechanism of Injury Matter?

2011 ◽  
Author(s):  
Michelle S. Kim ◽  
Jacob A. Bentley ◽  
Heather G. Belanger ◽  
Zoe Proctor-Weber ◽  
Tracy Kretzmer ◽  
...  
Keyword(s):  
Mechanism Of Injury ◽  
Mild Tbi ◽  
Symptom Complaints
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