Ankle Fractures

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Ankle Fractures

Ankle is an inherently very stable joint.

Three common classifications:

1) Lauge-Hansen Classification:
Supination-Adduction Ankle Fracture:
Stage 1 - transverse fracture of lateral malleolus or tear of lateral collateral ligaments
Stage 2 - stage 1 plus a fracture of medial malleolus

Supination-Eversion Ankle Fracture:
Stage 1 - rupture of the anteroinferior tibiofibular ligament – maybe with avulsion of bony fragment between tibia or fibula
Stage 2 - stage 1 plus a spiral oblique fracture of lateral malleolus
Stage 3 - stage 2 plus a fracture of posterior lip of the tibia
Stage 4 - stage 3 plus a fracture of the medial malleolus or a tear of the deltoid ligament

Pronation-Abduction Ankle Fracture:
Stage 1 - fracture of the medial malleolus or a tear of the deltoid ligament
Stage 2 - stage 1 plus a rupture of the anteroinferior, posteroinferior and transverse tibiofibular ligaments and a fracture of the posterior lip of the tibia.
Stage 3 - stage 2 plus an oblique supramalleolar fracture of the fibula

Pronation-Eversion Ankle Fracture:
Stage 1 same as stage 1 pronation-abduction injury
Stage 2 stage 1 plus tear of anteroinferior tibiofibular and interosseous ligament
Stage 3 stage 2 plus an interosseous tear and a spiral fracture of shaft of fibula
Stage 4 stage 3 plus a fracture of posterior lip of tibia

2) Weber Classification:
Type A Fibula fracture below syndesmosis (infrasyndesmotic)
Type A1 – isolated
Type A2 – with fracture of medial malleolus
Type A3 – with a posteromedial fracture
Type B Fibula fracture at level of syndesmosis (transyndesmotic)
Type B1 – isolated
Type B2 – with medial lesion (malleolus or ligament)
Type B3 – with medial lesion and fracture of posterolateral tibia
Type C Fibula fracture above syndesmosis (suprasyndesmotic)
Type C1 – simple diaphyseal fracture of the fibula
Type C2 – complex diaphyseal fracture of the fibula
Type C3 – proximal fracture of the fibula

3) AO-OATA (Arbeitsgemeinschaft fűr Osteosynthesefragan- Orthopaedic Trauma Assocaition)
More detail in Weber system

Management:

Weber Type A:
Usually does well with closed reduction (ligaments are still intact and ankle mortise is stable)  walking cast for 6 weeks
Surgery if – displaced, unstable, soft tissue disruption

Posterior tibial dysfunction may develop during healing process  will need foot orthoses to facilitate rehabilitation.

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