Ankle fractures are common orthopedic injuries that require careful evaluation and management. The ankle is a three-bone joint formed by the tibia, fibula, and talus. Stability is provided by static ligaments like the deltoid ligament and syndesmosis, as well as dynamic stabilizers like muscle forces. Evaluation involves a thorough history, exam, and imaging including plain films and stress views to classify the injury. Classification systems like Lauge-Hansen describe the mechanism of injury. Treatment depends on the fracture pattern and stability, ranging from casting to open reduction and internal fixation. Complications can include malunion, nonunion, infection, and post-traumatic arthritis if anatomy is not restored.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2. Ankle is a three bone joint composed of the tibia , fibula an
talus.
Talus articulates with the tibial plafond superiorly ,
posterior malleolus of the tibia posteriorly and medial
malleolus medially
Lateral articulation is with malleolus of fibula
Medial malleolus is shorter and anterior and thus axis of
the joint is 15 degrees of external rotation.
3. Stability of ankle:
(1) Static stabilizers
(a) Medial osteoligamentus complex:
Superficial deltoid ligament – Posterior tibio talar, Tibiocalcaneal and Tibio
navicular ligament
Deep deltoid ligament – Anterior tibio talar ligamnet
(b) Lateral Osteoligamentus complex:
Anterior talo fibular ligament (ATFL- weakest – most commen to injury in
ankle sprain)
Posterior talo fibular ligament
Calcaneo fibular ligament
(c) Syndesmosis:
Anterior inferior tibio fibular ligamnet
Posterior inferior tibio fibular ligamnet
Interosseous ligament
7. (2) Dynamic stabilizers
(a) Axial loading:
The joint is considered saddle-shaped with the dome itself is wider
anteriorly than posteriorly, and as the ankle dorsiflexes, the
fibula rotates externally through the tibiofibular syndesmosis,
to accommodate this widened anterior surface of the talar
dome. It forms a closed pack position which provides stability
to ankle
(b) Muscles around ankle joint
8. INTRODUCTION
Ankle fractures are among the most common injuries and
management of these fractures depends upon careful
identification of the extent of bony injury as well as soft tissue
and ligamentous damage.
Once defined, the key to successful outcome following
rotational ankle fractures is anatomic restoration and healing of
ankle mortise.
Low velocity injuries a/w rotational component
10. IMAGING AND DIAGNOSTIC MODALITIES
OTTAWA ANKLE RULES
To manage the large volume of ankle injuries of patients who
presented to emergency certain criteria has been established for
requiring ankle radiographs.
Pain exists near one or both of the malleoli PLUS one or more of the
following:
•Age > 55 yrs old
•Inability to bear weight
•Bone tenderness over the posterior edge or tip of either malleolus .
11. •Plain Films
–AP, Mortise, Lateral
views of the ankle
–Image the entire
tibia to knee joint
–Foot films when
tender to palpation
– Common
associated fractures
are:
•5th metatarsal
base fracture
•Calcaneal
fracture
Although the OTTAWA RULES have been validated and found to be both cost
effective and reliable (up to 100% sensitivity their implementation has been
inconsistent in general clinical practice
12. Quaitative analysis◦Tibiofibular overlap
< 10mm is abnormal - implies
syndesmotic injury
◦Tibiofibular clear space
◦> 5mm is abnormal - implies
syndesmotic injury
◦Talar tilt
◦> 2mm is considered abnormal
Consider a comparison with
radiographs of the normal side if there
are unresolved concerns of injury
13. Taken with ankle in
15-25 degrees of
internal rotation
Useful in
evaluation of
articular surface
between talar
dome and mortise
21. Radiography after reduction should be studied with
following requirements in mind:
•Normal relationship of ankle mortise must be restored.
•Weight bearing alignment of ankle must be at right angle to the
longitudinal axis of leg
•Counters of the articular surface must be as smooth as possible
22. • Classification systems
– Lauge-Hansen
– Weber
– OTA
• Additional Anatomic Evaluation
– Posterior Malleolar Fractures
– Syndesmotic Injuries
– Common Eponyms
23. Based on cadaveric study
• First word: position of foot at time of injury
• Second word: force applied to foot relative to
tibia at time of injury
Types:
Supination External Rotation
Supination Adduction
Pronation External Rotation
Pronation Abduction
24.
25. 1
3 2
4
Stage 1 Anterior
tibio- fibular
ligament
Stage 2 Fibula fx
Stage 3 Posterior
malleolus fx or
posterior tibio-
fibular ligament
Stage 4 Deltoid
ligament tear or
medial malleolus
fx
34. • Must x-ray knee to ankle to assess
injury
• Syndesmosis is disrupted in most cases
– Eponym: Maissoneuve Fracture
• Restore:
– Fibular length and rotation
– Ankle mortise
– Syndesmotic stability
35. Stage 1 Transverse
medial malleolus fx
distal to mortise
Stage 2 Anterior tib-
fib ligament/
Chaput’s fracture
Stage 3 Fibula fracture,
typically proximal to
mortise, often with a
butterfly fragment
1
2 3
36. Medial injury: tranverse to short oblique medial malleolar fracture
Lateral Injury: comminuted impaction type distal lateral malleolar fracture
37. Based on location of fibula
fracture relative to mortise
and appearance
Weber A - fibula distal to
Syndesmosis
Weber B - fibula at the level
of Syndesmosis
Weber C - fibula above the
level of Syndesmosis
Concept - the higher the
fibula the more severe the
injury
43. • Diastasis requires rupture of three strong ligaments and
iterosseous membrane, hence suggesting a very substantial
insult to ankle.
• Severe abduction forces causes torsional movement of
talus which forces the tibia and fibula causing
syndesmosis injury.
• Pronation type is frequently associated with syndesmosis
injury than Supination injuries.
• PER with deltoid rupture is particularly at high risk.
44. • Radiographic evaluation of Syndesmosis injury
• On AP view
– Tibio fibular clear space > 5mm (synd-A)
– Tibio fibular overlap <5mm (synd-B)
• On Mortise view
- Tibio fibular overlap <1mm (synd-B)
Comparison radiograph of opposite normal ankle is
more accurate.
45. • Intra operative stress testing:
(1)Lateral force to heel to displace the fibula
laterally (cotton’s test)
(2)Pulling the fibula laterally with a hook (hook
test) – most popular by the surgeons
(3)External rotation stress test
48. •
•
•
Maisonneuve Fracture
– Fracture of proximal fibula with
syndesmotic disruption
Volkmann Fracture
– Fracture of tibial attachment of
PITFL
– Posterior malleolar fracture type
Tillaux-Chaput Fracture
– Fracture of tibial attachment of
AITFL
49. Wagstaffe-LeFort fracture.
In the Wagstaffe-LeFort
fracture, seen here
schematically on the
anteroposterior view, the
medial portion of the fibula is
avulsed at the insertion of the
anterior tibiofibular ligament.
The ligament, however,
remains intact.
51. Isolated lateral malleolus fracture:
(with no instability)
- Truly isolated lateral malleolus #- stable
- SER 2 and SAD 1 type
- No tibiotalar incongruence
- Can be managed conservatively with
weight bearing cast, ankle brace, elastic
bandaging, stabilizing shoes, air stirrup
devices.
52. Lateral malleolus fracture with
associated instability
- A/w deltoid ligament failure (SER 4 )
- It may be Frank instability or Occult instability
Frank instability is diagnosed by
- obvious deformity at time of presentation
- clear displacement of talus on trauma
radiographs
Surgical treatment is required for lateral malleolus
in such cases.
53. • Occult ankle instability is checked by,
(a) Clinically –
swelling , tenderness, bruising over posterior aspect of medial
malleolus
(b) Stress view radiographs – mortise views
medial clear space >5mm
Surgical fixation of lateral malleolus is required in such cases.
* In many centers pragmatic approach of walking plaster is taken. If no
talar shift is noticed on one week follow up xray the ankle has
proved its stability.
54. SER-2
Negative Stress view
External rotation of
foot with ankle in
neutral flexion (00)
+ Stress View
Widened Medial Clear Space
SE-4
55. Isolated medial malleolus fracture:
• This includes
- anterior colliculus # with/without deep deltoid injuty
- posterio colliculus #
- supracollicular #
- chip avulsion fractures
Undisplaced fractures can be treated conservatively but
fractures with below knee cast for 6 weeks f/b
progressive ewight bearing and phyiotherapy
Fractures with significant displacement require fixation.
56. Bimalleolar fractures:
• By large bimalleolar fractures are unstable and should be
managed operatively.
• Only undisplaced bimalleolar fractures can be treated
conservatively.
Posterior malleolus fractures:
• Fractures involving >25% of joint surface should be managed
operatively ( McDaniel and Wilson et al.)
• pre operative ct scan is required
59. Fixation of lateral
malleolus
Simple oblique
fracture
(SER 3,4)
Inter frag screw
+/- neutralization plate
Or
Malleolar screw
Simple transverse
fracture
(PER 3,4)
Compression plate
Comminuted fracture
(PAB 3)
Bridge platting
Or
IM nailing
60.
61.
62.
63. Fixation of medial
malleolus
Vertical fracture
(SAD 2)
2 transverse screws
Or
Antiglide plate
Oblique fracture
Two 4.5 mm partially
threaded cancellous
screws perpendicular
to the fracture line
Transverse fracture
Tension bend wire
68. Early
• Wound infection/dehiscence
1–10% Superficial infections can be treated with antibiotics and dressings.
Deep infections may respond to suppression antibiotics until the fracture
has united but then usually require surgery to debride the wound and
obtain bacteriologic specimens.
Exposed hardware may require removal and the use of a spanning external
fixator until the infection is eradicated
• Loss of reduction 0–2%.
-Most common in conservatively treated, unstable fractures.
-In surgically treated fractures this may be related to inadequate initial
reduction, inadequate fixation, poor bone stock, peripheral neuropathy or
psychiatric illness.
• Malunion
• Osteoarthritis
• Thromboembolism
69. Late
• Osteoarthritis
Rare in low-energy fractures but up to 30% of unstable
patterns. May take several decades to become evident.
Higher when anatomical reduction of the mortise is not
achieved, other cases probably related to chondral injury at
time of injury.
May require functional bracing or an arthrodesis
• Nonunion
Most commonly encountered after nonoperative treatment.
Often asymptomatic, but if painful may require (revision)
fixation and possibly bone grafting
70. • Symptomatic hardware
• Compartment syndrome
Rare, associated with high-energy fractures
• Neuroma
The superficial peroneal, sural, and saphenous nerves are
all at risk in
the subcutaneous layer and injurymay result in a patch of
anesthetic, or worse, dysesthetic skin.