![]() ![]() This socket is only functional because the tibia (medial and posterior malleolus) and fibula (lateral malleolus) are held together tightly by the syndesmosis. The ankle is a pseudo-ball-and-socket joint the talus is the ball and the distal tibia and fibula act as the socket. They tend to cause fractures that are higher up the fibula and the rotational component of the injury may cause syndesmosis tears. In some cases, inversion coupled with rotation leads to a more complex injury. Avulsion injuries do not involve the syndesmosis and the ankle remains stable. This results in either a pure ligamentous injury (complete or partial tear) or avulsion of the tip of the fibula (the lateral malleolus). A pure inversion injury will result in tension being applied to the supporting soft tissues of the lateral ankle, particularly the lateral collateral ligament. Most ankle injuries occur because of an inversion injury. Pathology EtiologyĪnkle fractures may be the result of a vast array of injuries that range from an inversion injury to a complex high energy trauma sporting injury. inability to bear weight both immediately after injury and during clinical examinationĪn ankle x-ray series (AP and lateral views) is usually all that is needed to make a diagnosis.point tenderness at the posterior edge or tip of the medial malleoulus.point tenderness at the posterior edge or tip of the lateral malleoulus.The Ottawa ankle rules allow evidence-based decision making regarding the need for plain radiographs in patients with a traumatic ankle injury.Ī plain film radiograph is indicated in the setting of trauma if there are any of the following clinical examination findings 1: Most patients present following an episode of trauma with ankle pain, tenderness and an inability to weight bear. Risk factorsĬigarette smoking and obesity are both risk factors for ankle fractures. motor vehicle accident, sporting injury), while older patients present following minor trauma (e.g. Young patients present following injuries in relatively high-energy trauma (e.g. Type A fractures are usually stable and can be managed with simple measures, such as a plaster of paris cast.Ankle injuries, like many fractures have a bimodal distribution. They are inherently unstable and are more likely to require operative repair to achieve a good outcome. medial malleolus fracture or deltoid ligament injury presentĬategories B and C imply a degree of damage to the syndesmosis itself (which cannot be directly visualised on X-ray).tibiofibular syndesmosis disrupted with widening of the distal tibiofibular articulation.medial malleolus may be fractured or deltoid ligament may be tornįracture of the fibula proximal to the syndesmosis.tibiofibular syndesmosis intact or only partially torn, but no widening of the distal tibiofibular articulation.at the level of the ankle joint, extending superiorly and laterally up the fibula.usually stable: occasionally nonetheless requires an open reduction and internal fixation (ORIF) particularly if medial malleolus fracturedįracture of the fibula at the level of the syndesmosis.medial malleolus occasionally fractured.It has three categories: Type Aįracture of the fibula distal to the syndesmosis (the connection between the distal ends of the tibia and fibula). ![]() The Danis–Weber classification (often known just as the Weber classification) is a method of describing ankle fractures. ![]()
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