3. ตรวจร่างกายแรกรับ
A : can speak, no c-spine tenderness, full ROM of neck.
B : spontaneous breathing, equal chest movement, equal breath
sound, trachea in
midline, chest compression test- negative
C : BP 136/71, PR80/min, swelling of left ankle probably
hemarthrosis, no external wound seen.
D : E4V5M6 , pupils 3 mm RTLBE.
E : swelling of left ankle.
4. ตรวจร่างกาย
GA : A thai man, good consciousness.
HEENT : not pale conjunctivae, anicteric sclerae.
Heart : normal s1s2 ,no murmur.
Lungs : clear symmetrical breath sound both lungs, no adventitious
sound.
Abdomen : soft, not tender, no guarding, no rebound tenderness ,
normoactive
bowel sound.
Extremities :Left ankle swelling, limit ROM due to pain, no external
wound seen.
13. ANKLE ANATOMY
- Ankle is a three bone joint
composed of Tibia, fibula and
Talus. (true ankle joint).
Subtalar joint is joint between
talus and calcaneus.
- Talus articulates with the
tibia plafond superiorly, post.
Malleolus of the tibia
posteriorly and medial
malleolus medially.
- Lateral articulation is with
malleolus of fibula
16. INTRODUCTION
- Ankle fracture 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.
- Keys to successful outcome following rotational ankle fracture is
anatomic restoration
and healing of ankle mortise.
-30% of all sport in juries.
-12 % of traumatic injury
-Ligamentous : bony = 5:1.
17. WHO NEED RADIOGRAPH?
OTTAWA ANKLE RULES : sensitivity 97.5% decrease unnecessary x-ray
35%
* pain exists near both malleoli
+ 1 or more of these
- inability to bear weight
- bone tenderness over distal 6 cm. posterior edge or tip of
medial malleolus.
- bone tenderness over distal 6 cm. posterior edge or tip of lateral
malleolus
18. FILMS
- AP, MORTISE, LATERAL VIEW OF ANKLE.
- ENTIRE TIBIA TO KNEE JOINT.
- +/- FOOT FILM WHEN TENDER TO PALPATION.
- COMMON ASSOCIATED FRACTURES ARE
5th metatarsal base fracture
calcaneus fracture
35. FRACTURE DUE TO AXIAL
COMPRESSION
Pilon fracture
type1: articular fracture with minimal or no
displacement
type2 : displacement of the articular surface but with
minimal
or no comminution.
type3 : marked comminution as well as articular
impaction.
36. MANAGEMENT
Initial : compression, dressing, splint and elevation,
pain control.
Options : closed reduction, early sx ( ofx, unstable fx,
no soft tissue compromised), delayed treatment .
Medial malleolus
Non-displaced fx
may treated non-
opDisplaced fx requires
sx
High non-union
rate
lateral malleolus
2-3 mm displacement
> non-opNo medial widening/
syndesmosis injury >
non-op
Cast 6 weeks, follow
closely
37. INDICATION FOR SX
1. bimalleolar/ trimalleolar fx
2. syndesmotic disruption
3. Talar subluxation
4. joint incongruity/articular
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