For medial malleolar fractures a buttress plate may be used for shearing fractures. There is the medial malleolus with the deltoid complex 1 and the lateral malleolus with. Pdf despite an increasing awareness of injuries to pm in ankle fracture dislocations, there are still many open questions. The laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Displaced fractures are commonly treated with an open reduction and internal fixation. Ankle fractures symptoms, diagnosis and treatment bmj. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or.
The plan of care should be based upon the patients clinical exam and individual. The isolated lateral malleolar fracture dickyricky. In this case, we present a 53yearold male who sustained an isolated lateral malleolus fracture with an achilles tendon rupture. Lateral malleolar fracture displaced weber b weber c bimalleolar avhap educational talk 28 june 2011, duy thai. Patients were assigned into 4 groups according to the.
The pain, tenderness and swelling you are experiencing in the foot should gradually settle over a. 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. No previous study has described the dimensions of this fossa. Surgery is required internal fixation screwsplate if fracture is displaced and unstable. If nondisplaced and stable, these fractures can be treated nonoperatively with cast immobilization. Fractures of the lateral malleolus are the most common type of fracture. Lateral malleolus definition of lateral malleolus by. This immobilization may require more than just a below the knee cast or walker boot. The most common ankle fractures are breaks of the lateral malleolus end of the fibula, medial malleolus inside end of the tibia or both, which is called a bimalleolar fracture.
Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Clues to a probable ankle fracture include swelling, hematoma formation, and tenderness to pressure over the medial andor lateral malleolus. Tillaux fracture avulsion injury of the anterolateral epiphysis mechanism of injury external rotation the anteriorinferior tibiofibular ligament is stronger than the lateral physis and avulses the anterolateral epiphysis creating a salter harris iii fracture. Simplified diagnostic algorithm for laugehansen classification of. They can be distal, at or proximal to the joint line of the ankle. A lateral malleolar fracture occurs as a result of the twisting of the foot or ankle resulting from tripping or falling.
The fracture was reduced anatomically, and two or three stainless steel lag. Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. It is estimated that posterior malleolar fractures are found in 40% of rotational ankle fractures, but they may also occur in isolation, as a component of pilon fractures, or as a component of a distal tibia fracture. State the indication to fix posterior malleolar fractures. Ankle fracture fractures and its repair everything you need. Can be associated with a disruption of the tibiofibular syndesmosis. Anatomy, classification, and management of ankle fractures. This secondmost common type involves breaks of both the lateral malleolus and of the medial malleolus, the knobby bump. Within the present study, a 19yearold female who sustained an isolated lateral malleolar fracture was treated with open reduction and intramedullary mg screw fixation and then followed up. Twisting force on the ankle that leads to supination or pronation of the midfoot relative to the ankle and internal or external rotation of the talus within the joint. Lateral malleolar fracture an overview sciencedirect. Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year.
Trimalleolar fractures refer to a threepart fracture of the ankle. If a patient had a direct posterior dislocation or if the posterior malleolar fragments are over 25% of the articular width, the fracture is generally. It is not intended to be a substitute for ones clinical decisionmaking. A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities a trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect. The other two are the lateral and the posterior malleolus. Magnesium mg bioabsorbable screws are new biomaterials used in fracture fixation. The control material is composed of the series reported by. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. The classical treatment of posterior malleolar fractures, which limits open reduction and internal fixation of the posterior malleolar fragment to those with an articular fracture consisting of onethird or greater of the distal tibial articular surface, originates from a report by nelson and jensen 1. These regions are commonly referred to as the medial, lateral or posterior malleoli. Pseudarthrosis of the lateral malleolus 191 table 3. All the patients had a stable syndesmosis, less than 50% comminution, and had no other operations in the same extremity.
The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation 2 5. Malleolus fracture through posterolateral for the management of posterior malleolus fractures, more studies are still required, though it is already wellrecognized for medial and lateral structure. May be associated with a dislocation of the ankle joint. If the fracture is not out of place or is a very low fracture with. Xiao k, fang zh, hao c 2017 lateral malleolus hookplate fixation in the treatment of herscovici type b medial malleolar fractures. Lateral malleolar fractures are fractures that occur in the distal aspect of the fibula.
Lateral malleolus avulsion fracture this information will guide you through the next 6 weeks of your rehabilitation. Operative treatment of displaced lateral malleolar. Injuries to the deltoid ligament are estimated to occur in 10% to 36% of. Figure 1 shows the diagram of the lateral malleolus. Stability of the syndesmosis after posterior malleolar. Malleolar fractures include injuries of bones malleoli and or ligaments. Ankle fractures clas sically refer to malleolar injuries.
Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. A previously undescribed pitfall of lateral distal fibular locking plates is the risk of violating the lateral malleolar fossa mf. Fractures can occur at different levels of the medial malleolus. Epidemiology and treatment results for ankle fractures at. In the current literature, there is only one case report on the use of magnesium bioabsorbable screws in ankle fractures. The variable intermalleolar lig ament, which is a rein.
Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or with an injury to the ankle ligaments. These injuries typically occur when the ankle is either twisted or rolled. Cureus isolated lateral malleolar fracture treated with. There is the medial malleolus with the deltoid complex 1 and the lateral malleolus with the lateral ligaments 2. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond referred to as the posterior malleolus and the lateral malleolus.
Distribution of the lateral malleolar pseudarthroses of the followup material bg tvpe and stage of fracture compared with the distribution in a control material of ankle fractures. Lateral malleolus fracture healing time, treatment, icd 9, surgery, causes, diagnosis. Shawn f kane md, in the sports medicine resource manual, 2008. The standard indication for fixing a posterior malleolar fracture is a displaced fragment that involves more than 25%35% of the articular surface of the. Specific changes in the program will be made by the.
Lateral malleolus definition imaging pilon fracture of distal tibia ankle mortise oblique uncomplicated fracture of the lateral malleolus isolated fracture of the medial malleolus oblique fractures of the lateral and posterior malleoli bimalleolar fracture unstable lateral malleolar fracture mri showing osteochondral injury talus bone scan stress fracture distal fibula. Management of ankle fractures rhode island medical society. Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral malleolus following a. Emergency medicine physicians should consider the possibility of these injuries in combination. The fracture has occurred in a part of the bone which normally heals well without problems. Pediatric ankle fractures orthopaedic trauma association. The weber ankle fracture classification or danisweber classification is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint.
The commonly used weber classification relies solely on the level of the lateral malleolar fracture relative to the ankle joint line. What is the healing time for a lateral malleolus fracture. Non operative management of common fractures author. Lateral malleolus fracture healing time, treatment, icd. Fracture maps revealed the fracture characteristics and recurrent patterns of posterior malleolar fractures, which might help to improve the understanding of ankle fracture as well as. At times the talus may completely pop out of the ankle joint associated with the fracture, in which case we call this a fracture dislocation. Transverse medial malleolar fractures may be fixed with 1 or 2 cancellous lag screws, tension band technique, or. Discharge advice you have fractured a bone on the outer part of your ankle. These views were imported into macromedia fireworks mx software macromedia, san francisco, ca to overlap and orient fracture patterns onto a 3d template image of an intact ankle. Lateral malleolus avulsion fracture virtual fracture clinic. When a medial malleolus fracture occurs by itself, its called an isolated fracture. Usually, 48 weeks nonweightbearing followed by protected weightbearing with a cast. There is also the anterior tubercle with the anterior.
Achilles tendon and malleolar fractures are commonly seen in isolation, but only a few cases of combined injuries have been reported. Lateral malleolar fracture with concurrent achilles tendon. Commonly a lowenergy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus. Management of isolated lateral malleolar fracture new page 2. It is a break of the lateral malleolus, the knobby bump on the outside of the ankle in the lower portion of the fibula. Management of isolated lateral malleolar fracture 7184 aoasif group. When fractures of both the lateral and the medial malleolus is present, they are often referred to as a bimalleolar fracture. This study from 1940 showed their treatment and followup of 8 cases. Lateral malleolus avulsion fracture discharge advice. A lateral malleolar fracture takes aproximately 68 weeks to heal if properly immobilized and nonweightbearing. 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. Specifically, for weber a fracture, lcp distal fibula plate is much better than onethird tubular plate and lcp metaphyseal plate. Weber b fracture of the lateral malleolus with concomitant.
If the lateral malleolar fracture is comminuted, a bridge plate technique may be used. True the talus does appear to faithfully follow the lateral malleolus however yablon et al. Lateral malleolar fracture of the ankle young lae moon. Ankle fracture postop rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. A total of 168 patients meeting our inclusion criteria, an isolated displaced lateral malleolar fracture surgically treated by a knowles pin between 1995 and 2000, were studied. Comparison of three plate system for lateral malleolar.
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