Stability in ankle fractures

Abstract

Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures.Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures.Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especially those involving the posterior malleolus.Most isolated trans-syndesmotic fibular fractures (Weber-B, SER, AO 44-B) are stable and can safely be treated non-operatively.Posterior malleolus fractures, regardless of size, should be considered for surgical fixation to restore stability, reduce the need for syndesmosis fixation, and improve contact pressure distribution.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170057

Principles and guidelines in the management of ankle fractures in adults

“…Examination should include inspection for deformity, bruising, effusion and open wounds (BOA & BAPRAS 2017;Lampridis et al 2018). Palpation is performed in a methodical sequence across both the lateral and medial ankle as well as proximal fibula (for a potential Maisonneuve injury) (Lampridis et al 2018). Tenderness is suggestive of an underlying fracture rather than sprain.…”

“…Intravenous antibiotic prophylaxis should be given as soon as possible, preferably within 1 hour of injury (BOA & BAPRAS 2017 Following initial management, the ankle should be immobilised using a splint. Then, definitive treatment is chosen depending on the stability of the joint (Lampridis et al 2018). Patients with stable fractures or comorbidities rendering them unfit for surgery are treated conservatively with analgesia and immobilisation using a splint, short-leg cast or walker boot for a minimum of six weeks (Lampridis et al 2018;Moredecai et al 2011).…”

“…Then, definitive treatment is chosen depending on the stability of the joint (Lampridis et al 2018). Patients with stable fractures or comorbidities rendering them unfit for surgery are treated conservatively with analgesia and immobilisation using a splint, short-leg cast or walker boot for a minimum of six weeks (Lampridis et al 2018;Moredecai et al 2011). In addition to this, the BOA recommends close contact casts for patients over 60 years of age as an alternative to surgery if reduction can be maintained by the cast (BOA 2016).…”

Numerical Simulation of the Posterior Malleolus Fracture with the Finite Element Method

“…Ankle fractures are among the most common type of fractures in the lower extremity. The main causes of ankle fractures are its rolling in and out, side-to-side twisting and the flexure of the joint [1,2]. Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation [3,4].…”

Numerical Simulation of the Posterior Malleolus Fracture With the Finite Element Method

“…The malleolus fracture does refer to the fracture of one of the bones that the ankle joint consists of. The main causes of ankle fractures are its rolling in and out, the twisting side to side and the flexure of the joint [1]. This research focuses on posterior malleolus fracture which is considered as a rare injury mechanism in comparison with lateral and medial malleolus fracture [2], [3].…”