3. INTRODUCTION
• The ankle is a complex hinge joint composed of the Tibia, fibula, talus
and complex ligamentous system
• Ankle fractures are among the most common injuries
• Majority of ankle injuries are caused by indirect violence
• Management depends on careful identification of the extent of bony
injury as well as soft tissue and ligament damage
• If not treated properly, the ankle injuries are a source of disability in the
form of pain, instability and early degenerative arthritis of the ankle.
• The key to successful outcome is anatomic restoration and healing of
the ankle mortis
4. EPIDERMIOLOGY
• Incidence 187 per 100,000 adults annually
• Bimodal age distribution
• Young and active (15-24yrs): males predominance
• Elderly (75-84yrs): female predominance
• Mostly isolated malleolar fracture (70%)
• The most common form of ankle fracture is supination-external
rotation injury (weber-type B)
6. FUNCTIONAL ANATOMY
• The distal tibia surface referred to as the
“plafond” together with the medial and
lateral malleoli forms the “mortis”
• The talus articulates with the tibia plafond,
posterior, medial and lateral malleoli
• The talar dome is trapezoid in shape with
the anterior aspect 2.5cm wider than
posterior talus
• The tip of the lateral malleolus is more
distal compared to the medial
7. FUNCTIONAL ANATOMY
• The medial surface articulates with the medial facet of the talus
and is divided into the anterior and posterior colliculi for
attachment for superficial and deep parts of deltoid ligament
respectively
• Tibiotalar articulation is considered to be highly congruent such
that a 1mm talar shift within the mortise decrease the contact
area by 42%
14. MANAGEMENT
• The management of ankle injury is multi-disciplinary. Involving
the orthopedic surgeon, anesthetist, nurses, orthotist,
technicians, physiotherapist, radiologist, etc
• The aim of management: safe life, safe limb and rehabilitation
• Goals of management: Resuscitate, alleviate pain, maintain
joint congruity, prevent complications and rehabilitation
• The Advance Trauma and life support principle (ATLS) is
essential to care
15. MANAGEMENT
PRIMARY SURVEY
• A= Airway and cervical control
• B= Breathing and ventilation
• C= circulation and hemorrhage control
• D = Disability
• F= Fluids
26. MANAGEMENT
Classification
• Dannis- weber classification
• Type A : Infrasyndesmotic
• Type B: trans-syndesmotic
• B1: Isolated
• B2:involvement of medial lesions
• B3: involvement of medial lesions
and posterolateral tibia
• Type C: supra-syndesmotic (6cm)
• C1:diaphyseal fracture of the fibula,
simple
• C2:diaphyseal fracture of the fibula,
complex
• C3:proximal Robert Danis (1949) – Belgian general surgeon
Bernhard Geog weber in 1972 – swiss orthopedic surgeon
27. MANAGEMENT
LAUGE-HANSEN CLASSIFICATION
Supination - Adduction (SAD) 1. Talofibular sprain or distal fibular avulsion
2. Vertical medial malleolus and impaction of anteromedial distal tibia
Supination - External Rotation (SER) 1. Anterior tibiofibular ligament sprain
2. 2. Lateral short oblique fibula fracture (anteroinferior to posterosuperior)
3. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
4. Medial malleolus transverse fracture or disruption of deltoid ligament
Pronation - Abduction (PAB) 1. Medial malleolus transverse fracture or disruption of deltoid ligament
2. Anterior tibiofibular ligament sprain
3. Transverse comminuted fracture of the fibula above the level of the
syndesmosis
Pronation - External Rotation (PER) 1. Medial malleolus transverse fracture or disruption of deltoid ligament
2. Anterior tibiofibular ligament disruption
3. Lateral short oblique or spiral fracture of fibula (anterosuperior to
posteroinferior) above the level of the joint
4. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
Danish physician Sir Niels Lauge-Hansen in late 1940s and early 1950s
44. COMPLICATIONS
• Pain
• Deformity
• Ankle instability
• Septic arthritis
• Osteomyelitis
• Post traumatic osteoarthritis ≈ 15%
• Non union
• malunion
• Loss of occupation
• Related to surgery
45. FOLLOW UP
Essential to:
• Monitor treatment
• Compliance to physiotherapy
• Detect and treat complications
46. PREVENTION
• The Heddon’s matrix
• Host
• Vehicle
• Environment
• NB: Pre-crash, crash and post crash phases
50. CONCLUSION
• Ankle fractures are common presentation in our accident and
emergency
• The incidence is bimodal
• The principles of ATLS is essential to management
• Definitive care can be operative or non-operative
• Optimum anatomic reduction and stabilization is essential
