Ankle fractures by Dr Bipul Borthakur

1. ANKLE FRACTURES
Dr B Borthakur (Professor)
Dept of Orthopedics
SMCH

2.  Injuries around ankle commonly occurs from a slip while walking or fall or twisting
during play or from a road traffic accidents.
 If not treated properly it may lead to disability or even deformity.
Old age
Bony injury
young
ligamentous and soft tissue
components injuries

3. ANATOMY
 Ankle comprises of three bones tibia, fibula and talus.
 Talus articulates with the tibia plafond superiorly, posterior malleolus of the tibia
posteriorly and medial malleolus medially.
 Lateral articulation is with malleolus of fibula.

4. Ligaments
 The joint is supported by:
1. Fibrous capsule
 It surrounds the joint and is attached all around the articular margins
2. Lateral ligament
 It consists of three bands
 Anterior-talofibular ligament
 Calcaneofibular ligament
 Posterior talofibular ligament

5. 3. Deltoid or medial ligament
 This is a very strong triangular ligament present on the medial side of the ankle.
 Superficial layer Deep layer
• Tibiocalcaneal ligament * Anterior tibiotalar ligament
• Tibionavicular ligament * Posterior deep tibiotalar ligament
• Posterior superficial tibiotalar ligament
• Tibiospring ligament

6. Movement
 Dorsiflexion
 Tibialis anterior
 Accessory muscles: Extensor digitorum anterior longus
Extensor hallucis longus
Peroneus tertius
 Plantar flexion
 Gastrocnemius
 Soleus
 Accessory muscles: Plantaris
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus

7. Syndesmosis
• maintains integrity between tibia and fibula
• resists axial, rotational, and translational forces

8. Mechanism of fracture
 Fall from height
 Twisting
 Direct trauma over ankle

9. Classification
Weber
Type A= Infrasyndesmotic
Type B= Transsyndesmotic
Type C= Suprasyndesmotic

10. Lauge-Hansen classification
 It is based on mechanism of injury.

11. Clinical presentation
 Swelling
 Pain and tenderness
 Restriction of movement
 Ecchymosis
 Deformity

12. Investigation
 Plain radiograph
 AP view
 Lateral view
 Mortise view

13. Fractures
 Isolated medial malleolus fracture

14.  Isolated lateral malleolus fracture

15.  Bimalleolar fracture

16.  Posterior malleolus fracture

17. Treatment
 Non-operative
 Below knee cast
 Indications:
 Isolated nondisplaced medial or lateral malleolus fracture
 Isolated lateral malleolus fracture with <3mm displacement or no talar shift.
 Posterior malleolar fracture with <25% joint involvement or <2mm step-off.

18. Operative
 Indications:
 Talar displacement
 Displaced isloateral medial or lateral malleolus fracture
 Bimalleolar fracture
 Posterior malleolar fracture with >25% or >2mm step-off
 Open malleolar fracture
 Malleolar nonunion

19. Operative modalities
 Open reduction and internal fixation
 Plating
 Cancellous /Malleolar screws
 Tension band wiring

20. Medial malleolus fracture treated with
Tension Band Wiring
Medial malleolus fracture treated
with malleolar screw

21. Lateral malleolus fracture treated with screw and neutralisation plate

22. Complication
 Infection
 Malunion
 Nonunion
 Post-operative stiffness
 Post-traumatic arthritis

23. THANK YOU