Ankle Fractures: Biomechanical Insights
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Questions and Answers

What is the primary reason for delaying definitive surgery on ankle fractures for 10-14 days?

  • To ensure that the fracture is properly stabilized with internal fixation before surgery
  • To allow time for the fracture to begin healing before surgery
  • To give the patient time to regain some range of motion before surgery
  • To allow for the dissipation of soft tissue swelling, which can reduce the risk of wound complications (correct)

    • What is the primary benefit of using indirect reduction techniques for fibular fractures with excessive comminution or poor bone quality?

  • They can help to restore fibular length and rotation, which is crucial for a stable ankle (correct)
  • They can help to ensure that the fracture is properly stabilized with internal fixation before surgery
  • They can help to reduce the risk of wound complications after surgery
  • They can help to prevent the need for additional imaging studies, such as CT scanning

    • Which of the following is NOT one of the A/O principles of internal fixation mentioned in the text?

  • Rigid internal fixation
  • Atraumatic soft tissue handling with minimal periosteal stripping
  • Anatomical reduction
  • Minimally invasive surgery (correct)

    • What is the purpose of the "push-pull" technique described in the text?

    <p>To help restore fibular length and rotation (B)</p> Signup and view all the answers

    What is the primary purpose of the A/O laminar spreader in the "push-pull" technique?

    <p>To apply pressure to the distal fragment of the fibula, helping to restore its length (D)</p> Signup and view all the answers

    Which of the following is a possible complication that might be avoided by delaying definitive surgery for 10-14 days?

    <p>Infection (C)</p> Signup and view all the answers

    Why is early range of motion a key principle of internal fixation?

    <p>It helps to restore the function of the joint (D)</p> Signup and view all the answers

    In the context of fibular stabilization, what is the primary difference between a dorsal anti-glide technique and a lateral neutralization technique?

    <p>The location of the plate placement (B)</p> Signup and view all the answers

    In the case of a pronation-abduction ankle fracture, what type of plate fixation is typically employed?

    <p>Bridge plate (B)</p> Signup and view all the answers

    What is the recommended method for restoring fibular length in a pronation-abduction ankle fracture?

    <p>Indirect push-pull technique (B)</p> Signup and view all the answers

    Which of the following scenarios would likely warrant the use of a locking plate for a pronation-abduction ankle fracture?

    <p>Severe comminution with unstable syndesmosis (C)</p> Signup and view all the answers

    In a pronation-external rotation ankle fracture, what type of plate fixation is typically recommended for fracture lines immediately proximal to the ankle mortise?

    <p>1/3 tubular plate (C)</p> Signup and view all the answers

    Which of the following statements accurately describes the management of fibular length and rotation in a Maisonneuve injury?

    <p>Fibular length and rotation can be provisionally restored using a reduction forceps (B)</p> Signup and view all the answers

    When managing a posterior malleolus fracture, what percentage of the tibial articular surface involvement is generally considered a threshold for requiring fixation?

    <p>25% (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the rationale for restoring fibular length in a posterior malleolus fracture?

    <p>Restoring fibular length indirectly reduces the posterior malleolus (D)</p> Signup and view all the answers

    In the context of the provided content, why is syndesmotic instability anticipated in pronation-abduction ankle fractures?

    <p>The fracture pattern predisposes to syndesmotic instability (A)</p> Signup and view all the answers

    In what type of ankle fracture is a three-hole 1/3 tubular plate used for a washer effect laterally?

    <p>Maisonneuve injury (C)</p> Signup and view all the answers

    What is the critical transition zone proximal to the ankle mortise?

    <p>3.0 cm to 4.5 cm (A)</p> Signup and view all the answers

    What does the text suggest about the criteria for syndesmosis fixation in the presence of a deep deltoid ligament tear?

    <p>These criteria are not entirely correct and may need to be adjusted based on individual cases. (B)</p> Signup and view all the answers

    What is the significance of the medial variant, or tension failure of the deep deltoid ligament with an avulsion fracture of the anterior colliculus?

    <p>It may contribute to syndesmotic instability, even with anterior colliculus fixation. (C)</p> Signup and view all the answers

    What percentage of supination-external rotation type IV patterns with a deltoid ligament injury were found to have residual syndesmotic instability following rigid lateral fixation?

    <p>39% (C)</p> Signup and view all the answers

    What type of test is recommended to be performed intraoperatively following definitive fracture fixation to assess for residual syndesmotic instability?

    <p>External rotation stress test (A)</p> Signup and view all the answers

    What is the main reason for the controversy surrounding syndesmosis fixation?

    <p>The variability in syndesmotic injuries and the optimal treatment approach. (C)</p> Signup and view all the answers

    Which of the following ankle fracture patterns are mentioned in the text as requiring an intraoperative external rotation stress test?

    <p>Supination-external rotation, pronation-abduction, pronation-external rotation (D)</p> Signup and view all the answers

    What is the typical incidence of atypical posteromedial variant patterns?

    <p>6-11% (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of atypical posteromedial variant patterns?

    <p>Anterior subluxation of the talus (B)</p> Signup and view all the answers

    What radiographic sign is indicative of a vertical shear pattern in atypical posteromedial variant fractures?

    <p>Double contour sign (D)</p> Signup and view all the answers

    What imaging modality is recommended for atypical posteromedial variant fractures?

    <p>CT scan (C)</p> Signup and view all the answers

    What is the preferred surgical approach for fixing atypical posteromedial variant patterns, according to the author?

    <p>Posterior medial approach in the supine position (A)</p> Signup and view all the answers

    What specific technique is used to address the posteromedial subluxation of the talus during surgery?

    <p>Buttress plate fixation (B)</p> Signup and view all the answers

    Which of the following is NOT a common postoperative protocol for ankle fractures, as described in the text?

    <p>Antibiotics (D)</p> Signup and view all the answers

    What can contribute to a residual posteromedial subluxation of the talus during surgery?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of these options is NOT a current controversy in syndesmotic fixation?

    <p>Implant size and shape (B)</p> Signup and view all the answers

    Which of these options is NOT a factor that may necessitate a medial arthrotomy during syndesmosis fixation?

    <p>A large pelvic clamp that inhibits reduction (B)</p> Signup and view all the answers

    What is the recommended trajectory for screw fixation of the syndesmosis?

    <p>2.0 cm proximal to the ankle mortise, angling 30 degrees from posterolateral to anteromedial in the axial plane, and parallel to the ankle joint in the coronal plane. (A)</p> Signup and view all the answers

    What is the primary function of the K-wire used in syndesmosis fixation?

    <p>To prevent anterior or posterior translation of the fibula within the incisura fibularis (C)</p> Signup and view all the answers

    The text suggests that obtaining medial and posterior fixation may...?

    <p>Increase overall stability of the construct (D)</p> Signup and view all the answers

    What is the "gold standard" for syndesmosis fixation as mentioned in the text?

    <p>Screw fixation (B)</p> Signup and view all the answers

    What is the purpose of using a 2-hole or 3-hole 1/3 tubular plate during syndesmosis fixation?

    <p>To act as a washer to distribute stresses away from the screwhead (D)</p> Signup and view all the answers

    What is the author's preferred method for performing an external-rotation stress test during syndesmosis fixation?

    <p>Performing the test before and after implant placement (D)</p> Signup and view all the answers

    What is the primary advantage of using a dorsal anti-glide plate for fibula fractures, as described in the text?

    <p>It is less likely to cause soft tissue complications compared to other fixation methods. (C)</p> Signup and view all the answers

    What complication is associated with lateral malleolar plate placement or prominent distal screw heads?

    <p>Increased risk of peroneal tendon irritation and tendinous lesions. (D)</p> Signup and view all the answers

    What is the recommended approach for treating a supination-adduction fracture of the fibula according to the text?

    <p>Open reduction and internal fixation with a hook plate. (A)</p> Signup and view all the answers

    What is the preferred method for treating a nondisplaced fibula fracture, as described in the text?

    <p>Closed reduction and percutaneous fixation with a retrograde screw. (A)</p> Signup and view all the answers

    What specific consideration must be made during medial fixation of a supination-adduction fracture of the fibula?

    <p>Positioning the plate in a transverse orientation to prevent secondary shortening and displacement. (D)</p> Signup and view all the answers

    What specific issue is addressed by the text's description of reflecting the fragment distally and disimpacting the impacted area of the tibial plafond?

    <p>Treating a potential impaction injury to the tibial plafond. (C)</p> Signup and view all the answers

    What is the primary rationale for performing an open reduction in supination-external rotation fibula fracture, as described in the text?

    <p>To remove potential soft tissue interposition that can hinder healing. (C)</p> Signup and view all the answers

    What is the preferred method for treating avulsion fragments in supination-adduction fibula fractures?

    <p>No fixation is typically required. (B)</p> Signup and view all the answers

    What is the typical range of incidence for atypical posteromedial variant ankle fracture patterns?

    <p>6-11% (D)</p> Signup and view all the answers

    What is the radiographic sign indicative of a vertical shear pattern in atypical posteromedial variant ankle fractures?

    <p>Double contour sign (A)</p> Signup and view all the answers

    What is the preferred surgical approach for fixing atypical posteromedial variant ankle fractures, according to the text?

    <p>Posteromedial approach in the supine position (A)</p> Signup and view all the answers

    Which of these options is NOT a characteristic of atypical posteromedial variant ankle fracture patterns?

    <p>Anteromedial subluxation of the talus (D)</p> Signup and view all the answers

    What is the primary biomechanical function of the fibula in relation to the ankle joint?

    <p>Resist the external rotation of the talus and lateral translation of the talus. (B)</p> Signup and view all the answers

    Which statement accurately describes the role of the deep deltoid ligament in ankle stability?

    <p>It provides significant resistance to external rotation of the talus, acting as a primary static stabilizer. (B)</p> Signup and view all the answers

    What is the significance of the statement that 'ankle fractures represent a spectrum of injury patterns from simple to complex'?

    <p>It emphasizes the importance of a thorough evaluation and individualized treatment plan. (B)</p> Signup and view all the answers

    Based on the biomechanical considerations discussed, which of the following situations is MOST likely to contribute to post-traumatic arthritis?

    <p>Lateral translation of the talus by 2mm, causing a 64% reduction in contact area. (B)</p> Signup and view all the answers

    What is the primary rationale for using a 'push-pull' technique during internal fixation of fibular fractures?

    <p>To achieve anatomical reduction and improve the stability of the fracture. (B)</p> Signup and view all the answers

    What is the key transition zone proximal to the ankle mortise that is mentioned in the text?

    <p>The area where the anterior and posterior tibiofibular ligaments converge, crucial for syndesmotic stability. (C)</p> Signup and view all the answers

    Why is obtaining medial fixation considered crucial in the management of certain types of ankle fractures?

    <p>It provides stability to the joint, especially in cases of deltoid ligament injuries and supination-external rotation fractures. (A)</p> Signup and view all the answers

    What is the primary rationale for performing an external rotation stress test intraoperatively during ankle fracture surgery?

    <p>To ensure that the fracture is anatomically reduced and the syndesmosis is stable, preventing malunion. (D)</p> Signup and view all the answers

    What type of fracture pattern is typically associated with instability of the syndesmosis?

    <p>Pronation-Abduction (B), Pronation-External Rotation (C)</p> Signup and view all the answers

    Which of the following fracture patterns commonly involves an impaction injury to the medial tibial plafond?

    <p>Supination-Adduction (A)</p> Signup and view all the answers

    Which of the following fracture patterns is associated with a spiral oblique fibula fracture above the ankle mortise?

    <p>Pronation-External Rotation (C)</p> Signup and view all the answers

    Which of the following radiographic criteria can indirectly indicate fibular length in a sagittal plane assessment?

    <p>Presence or absence of a posterior malleolar fracture (D)</p> Signup and view all the answers

    What is the typical percentage of ankle fractures that are classified as a supination-adduction pattern?

    <p>10% - 20% (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the pronation-abduction pattern?

    <p>It is typically associated with lateral comminution of the fibula due to bending forces. (C)</p> Signup and view all the answers

    Which of the following is a common radiographic finding in a supination-adduction ankle fracture?

    <p>A vertical shear fracture of the medial malleolus (D)</p> Signup and view all the answers

    What type of ankle fracture is commonly associated with the Maisonneuve injury?

    <p>Pronation-External Rotation (C)</p> Signup and view all the answers

    What is the primary complication associated with the use of an antiglide plate for fixation of lateral malleolar fractures?

    <p>Iatrogenic peroneal tendon injuries (D)</p> Signup and view all the answers

    Which of the following is NOT a factor that may necessitate a medial arthrotomy during syndesmosis fixation?

    <p>Isolated deep deltoid ligament tear (B)</p> Signup and view all the answers

    Which imaging modality is recommended for evaluating atypical posteromedial variant fractures?

    <p>CT scan (B)</p> Signup and view all the answers

    In the context of supination-adduction fibula fractures, what specific issue is addressed by reflecting the fragment distally and disimpacting the impacted area of the tibial plafond?

    <p>Restoring tibial plafond congruity (D)</p> Signup and view all the answers

    What is the preferred method for treating avulsion fragments in supination-adduction fibula fractures, as described in the text?

    <p>Open reduction and internal fixation with screws (A)</p> Signup and view all the answers

    What is the primary reason for the Lauge-Hansen classification system's significance in ankle fracture treatment?

    <p>It established a definitive link between the mechanism of injury and the specific fracture patterns observed. (D)</p> Signup and view all the answers

    According to the Lauge-Hansen classification, which of the following accurately describes the mechanism of injury and its associated structures in a supination-external rotation ankle fracture?

    <p>External rotation force applied to the foot in a supinated position, resulting in damage to the lateral structures. (B)</p> Signup and view all the answers

    In the context of a supination-external rotation ankle fracture, which of the following represents a potential complication that underscores the importance of carefully assessing syndesmotic stability?

    <p>Persistent joint instability due to a residual syndesmotic tear after surgery. (A)</p> Signup and view all the answers

    Which of the following injuries is specifically associated with the 'combination medial injury variant' described by Tornetta in supination-external rotation ankle fractures?

    <p>A deep deltoid ligament tear and an avulsion fracture of the anterior colliculus. (C)</p> Signup and view all the answers

    Which of the following statements accurately represents the rationale behind performing an external rotation stress test during syndesmotic fixation?

    <p>To evaluate the integrity of the syndesmosis repair and ensure that the ligaments are adequately stabilized. (C)</p> Signup and view all the answers

    What is the primary reason for the controversy surrounding syndesmosis fixation in ankle fracture management?

    <p>Lack of definitive evidence supporting or refuting the effectiveness of syndesmotic fixation in improving clinical outcomes. (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the recommended approach for managing a nondisplaced fibular fracture, as outlined in the text?

    <p>Conservative nonsurgical management with immobilization and early weight-bearing as tolerated. (C)</p> Signup and view all the answers

    The text highlights a specific consideration during medial fixation of a supination-adduction fracture of the fibula. What is this key consideration?

    <p>Avoiding excessive screw penetration into the joint space to minimize the risk of osteochondral injury and arthritis. (D)</p> Signup and view all the answers

    Which of the following statements accurately reflects why the author prefers to delay definitive surgery on ankle fractures for 10-14 days?

    <p>The delay provides time for additional imaging studies, such as CT scans, and facilitates comprehensive preoperative planning. (D)</p> Signup and view all the answers

    When applying the indirect 'push-pull' technique for fibular fracture reduction, what is the purpose of the A/O laminar spreader?

    <p>The laminar spreader acts as a lever to apply force to the proximal fragment, facilitating closed reduction of the fibular fracture. (C)</p> Signup and view all the answers

    Which of the following scenarios would necessitate the use of an indirect reduction technique (like the 'push-pull' method) for fibular fracture reduction?

    <p>When the fracture is comminuted, but the bone quality is excellent. (A)</p> Signup and view all the answers

    The author describes two distinct fibular stabilization techniques, the dorsal anti-glide and the lateral neutralization. What is the primary difference between these two techniques?

    <p>The dorsal anti-glide technique primarily stabilizes the fibula in the sagittal plane, while the lateral neutralization technique stabilizes the fibula in the coronal plane. (B)</p> Signup and view all the answers

    Which of the following is NOT a key principle outlined by A/O for internal fixation as described in the text?

    <p>Use of locking plates for all fractures to ensure maximal stability. (B)</p> Signup and view all the answers

    In the 'push-pull' technique, what is the role of the screw placed proximal to the plate?

    <p>The additional screw, along with the A/O laminar spreader, acts as a lever to apply traction to the proximal fragment. (A)</p> Signup and view all the answers

    Why is restoration of fibular length and rotation crucial in ankle fracture management?

    <p>Fibular length and rotation directly impact the integrity of the ankle joint, influencing stability and function. (B)</p> Signup and view all the answers

    The provided excerpt discusses a rationale for delaying definitive surgery for certain ankle fractures. Which of the following is a potential consequence of NOT delaying surgery in this context?

    <p>Increased chance of wound complications due to persistent soft tissue swelling. (A)</p> Signup and view all the answers

    Which of the following ankle fracture patterns is associated with a high incidence of syndesmotic instability?

    <p>Pronation-Abduction (B), Pronation-External Rotation (C)</p> Signup and view all the answers

    The supination-adduction ankle fracture pattern typically involves a transverse fracture of the medial malleolus.

    <p>False (B)</p> Signup and view all the answers

    What type of fracture is often observed in the supination-adduction ankle fracture pattern, involving the medial malleolus?

    <p>Vertical shear fracture</p> Signup and view all the answers

    The ______ injury is a specific type of pronation-external rotation ankle fracture.

    <p>Maisonneuve</p> Signup and view all the answers

    Match the following ankle fracture patterns with their associated features:

    <p>Supination-Adduction = Vertical shear fracture of the medial malleolus Pronation-Abduction = Tension failure of the deep deltoid ligament Pronation-External Rotation = Spiral oblique fibula fracture above the ankle mortise None of the above = Impaction injury to the lateral tibial plafond</p> Signup and view all the answers

    Ankle fractures are typically caused by high-energy, rotational injuries.

    <p>False (B)</p> Signup and view all the answers

    Which of the following is NOT a factor contributing to post-traumatic arthritis in ankle fractures?

    <p>Increased bone density (D)</p> Signup and view all the answers

    What is the primary function of the fibula in maintaining ankle joint stability?

    <p>The fibula acts as a post to resist lateral translation of the talus.</p> Signup and view all the answers

    The ______ ligament is a primary static stabilizer of the ankle joint and resists external rotation of the talus.

    <p>deep deltoid</p> Signup and view all the answers

    Which of the following ankle fracture patterns commonly involves syndesmotic instability?

    <p>Pronation-abduction ankle fracture (D)</p> Signup and view all the answers

    Match the following ankle fracture patterns with their typical surgical approach:

    <p>Pronation-abduction ankle fracture = Lateral plate fixation Posterior malleolus fracture = Open reduction and internal fixation if greater than 25% articular surface involvement Supination-external rotation ankle fracture = Open reduction and internal fixation for fibula fracture Atypical posteromedial variant fracture = Open reduction and internal fixation for posteromedial subluxation of the talus</p> Signup and view all the answers

    For simple ankle fracture patterns, patients remain nonweight-bearing for 6 weeks postoperatively.

    <p>True (A)</p> Signup and view all the answers

    What is the recommended duration for obtaining serial weight-bearing radiographs postoperatively in patients with ankle fractures requiring syndesmosis fixation?

    <p>12 months (D)</p> Signup and view all the answers

    The Lauge-Hansen classification is used to classify ankle fractures based on ____ and _____.

    <p>injury mechanism, radiographic findings</p> Signup and view all the answers

    Match the following postoperative protocols with their corresponding ankle fracture types:

    <p>Simple patterns = Nonweight-bearing for 6 weeks, transition to regular shoe-wear Fracture patterns requiring syndesmosis fixation = Nonweight-bearing for 10 weeks Posteromedial variant patterns = Nonweight-bearing for 10 weeks, emphasis on ankle dorsiflexion</p> Signup and view all the answers

    What specific surgical technique is recommended for addressing posteromedial subluxation of the talus during surgery for atypical posteromedial variant patterns?

    <p>Direct fixation of the posteromedial fragment using a small fragment screw or washer.</p> Signup and view all the answers

    Syndesmotic screws are routinely removed at 12 months postoperatively, regardless of symptoms.

    <p>False (B)</p> Signup and view all the answers

    What is the main goal of surgical stabilization for ankle fractures, as described in the text?

    <p>Atraumatic soft tissue management, rigid internal fixation, and early range of motion exercises.</p> Signup and view all the answers

    Which of the following is NOT a reason for delaying definitive surgery on ankle fractures for 10-14 days?

    <p>To improve bone quality (B)</p> Signup and view all the answers

    What is considered the gold standard for syndesmosis fixation?

    <p>Screw fixation (C)</p> Signup and view all the answers

    Position screws should be placed as lag screws for optimal syndesmotic fixation.

    <p>False (B)</p> Signup and view all the answers

    What is the recommended angle for screw fixation of the syndesmosis in the axial plane?

    <p>30 degrees</p> Signup and view all the answers

    A large pelvic clamp is used to obtain ________ of the syndesmosis before implant placement.

    <p>reduction</p> Signup and view all the answers

    Match the screw sizes to their typical use in syndesmotic fixation:

    <p>3.5 mm = Standard cortical screw 4.0 mm = Larger cortical screw 4.5 mm = Maximum cortical reinforcement 2.0 mm = Screw for smaller applications</p> Signup and view all the answers

    What role does the K-wire play during the syndesmosis fixation procedure?

    <p>It prevents translation of the fibula. (C)</p> Signup and view all the answers

    A medial arthrotomy is unnecessary if complete reduction is achieved.

    <p>True (A)</p> Signup and view all the answers

    What is the purpose of conducting an external-rotation stress test during syndesmosis fixation?

    <p>To assess for residual syndesmotic instability</p> Signup and view all the answers

    What is the main purpose of delaying definitive surgery for ankle fractures?

    <p>To minimize soft tissue swelling (D)</p> Signup and view all the answers

    Atraumatic soft tissue handling is considered one of the A/O principles of internal fixation.

    <p>True (A)</p> Signup and view all the answers

    What is critical for restoring the stability of the ankle mortise?

    <p>Restoration of fibular length and rotation</p> Signup and view all the answers

    In cases of excessive comminution, the __________ technique can help restore fibular length.

    <p>indirect push-pull</p> Signup and view all the answers

    Match the following techniques with their purposes:

    <p>Dorsal anti-glide = Stabilization for supination-external rotation fractures Lateral neutralization = Support for lateral fracture lines Indirect push-pull = Restoration of fibular length and rotation A/O principles = Guidelines for internal fixation</p> Signup and view all the answers

    What imaging technique may be utilized prior to definitive surgery?

    <p>Computed tomography (CT) (B)</p> Signup and view all the answers

    Early range of motion is discouraged after internal fixation.

    <p>False (B)</p> Signup and view all the answers

    What type of screw is typically used in conjunction with a simple one-third tubular plate for fibular stabilization?

    <p>3.5-mm cortical screws</p> Signup and view all the answers

    What is the primary focus of the study conducted by Minihane et al. in 2006?

    <p>Comparing lateral locking plate and antiglide plate effectiveness (A)</p> Signup and view all the answers

    Syndesmotic instability is generally not a concern in Weber B ankle fractures.

    <p>False (B)</p> Signup and view all the answers

    What implications do trimalleolar fractures have for talar stability?

    <p>They can risk talar instability due to posterior malleolar impaction.</p> Signup and view all the answers

    The dorsal antiglide plate is specifically used for treating __________ fractures of the distal fibula.

    <p>Danis-Weber type B</p> Signup and view all the answers

    Which of the following studies discusses the mechanical considerations for a syndesmosis screw?

    <p>Boden et al. (1989) (A)</p> Signup and view all the answers

    Match the following authors with their respective studies or findings:

    <p>Winkler B = Dorsal antiglide plate in Danis-Weber type B fractures Gardner MJ = Great syndesmotic stability in posterior malleolar fixation Boden SD = Mechanical considerations for syndesmosis screw Weber M = Talar stability in trimalleolar fractures</p> Signup and view all the answers

    The study by Weber and Krause in 2005 found no relationship between plate position and peroneal tendon lesions.

    <p>False (B)</p> Signup and view all the answers

    What technique has been assessed for treating displaced lateral malleolus fractures?

    <p>Antiglide technique</p> Signup and view all the answers

    Following rigid lateral fixation in supination-external rotation type IV ankle fracture patterns with a deltoid ligament injury, what percentage of cases exhibit residual syndesmotic instability?

    <p>39% (B)</p> Signup and view all the answers

    A deep deltoid ligament tear proximal to the 3.0 to 4.5 cm transition zone always necessitates syndesmosis fixation, even if medial fixation is possible.

    <p>False (B)</p> Signup and view all the answers

    In a Maisonneuve injury, the preferred method for fixing the fibular fracture involves an anterior-to-posterior screw fixation starting ______ and aiming ______.

    Signup and view all the answers

    Which of these fracture patterns commonly requires bridge plate fixation?

    <p>Pronation-Abduction (B)</p> Signup and view all the answers

    In pronation-external rotation fractures, fibular fracture lines immediately proximal to the ankle mortise can be stabilized with a 3.5-mm reconstruction plate.

    <p>False (B)</p> Signup and view all the answers

    What is the general rule of thumb regarding the size of a posterior malleolar fragment that necessitates fixation?

    <p>Fragments involving 25% or more of the tibial articular surface are associated with posterior instability and require stabilization.</p> Signup and view all the answers

    The author prefers a [BLANK]-type plate for Maisonneuve injuries.

    <p>reconstruction</p> Signup and view all the answers

    Match the ankle fracture patterns with their preferred plate fixation methods:

    <p>Pronation-Abduction = 3.5-mm reconstruction plate Pronation-External Rotation (proximal fracture lines) = 3.5-mm reconstruction plate or LC-DC-type plate Pronation-External Rotation (fracture lines near ankle mortise) = 1/3 tubular plate Maisonneuve injuries (distal to fibular neck) = Plate fixation is preferred</p> Signup and view all the answers

    Which of these ankle fracture patterns is MOST commonly associated with instability of the syndesmosis?

    <p>Pronation-Abduction (B)</p> Signup and view all the answers

    The pronation-external rotation ankle fracture pattern is always associated with a Maisonneuve injury.

    <p>False (B)</p> Signup and view all the answers

    What specific radiographic criteria can be used to assess the inherent stability of a malleolar fracture?

    <p>Coronal plane symmetry (particularly in the absence of a medial fracture), preservation of fibular length, and the 'Shenton's line of the ankle' can be assessed.</p> Signup and view all the answers

    The ______ pattern of ankle fracture often involves a vertical shear fracture of the medial malleolus.

    <p>Supination-Adduction</p> Signup and view all the answers

    Match the following ankle fracture patterns with their primary features:

    <p>Supination-Adduction = Vertical shear fracture of the medial malleolus, lateral malleolus avulsion or lateral ligament injury Pronation-Abduction = Tension failure of the deep deltoid ligament, AITFL and PITFL failure, transverse fibula fracture Pronation-External Rotation = Tension failure of the deep deltoid ligament, AITFL failure, spiral oblique fibula fracture, PITFL or posterior malleolus fracture</p> Signup and view all the answers

    Which of the following is NOT a radiographic sign that is indicative of a relatively stable ankle fracture?

    <p>Presence of a posterior malleolar fracture (D)</p> Signup and view all the answers

    The presence of an impaction injury to the lateral tibial plafond is often associated with the pronation-abduction pattern.

    <p>False (B)</p> Signup and view all the answers

    What is a common injury associated with the pronation-external rotation ankle fracture pattern?

    <p>A Maisonneuve injury is commonly associated with pronation-external rotation ankle fractures. It involves a spiral oblique fibula fracture above the ankle mortise and a disruption of the interosseous membrane and the proximal fibula.</p> Signup and view all the answers

    What is the recommended nonweight-bearing period for patients with syndesmosis fixation after surgery?

    <p>10 weeks (B)</p> Signup and view all the answers

    Syndesmosis screws are routinely removed after 6 months, regardless of symptoms.

    <p>False (B)</p> Signup and view all the answers

    For how long should serial weight-bearing radiographs be obtained postoperatively for typical ankle fractures?

    <p>at least 6 months</p> Signup and view all the answers

    Aggressive ankle range of motion, particularly ankle ______, is emphasized after surgery for posterior injuries.

    <p>dorsiflexion</p> Signup and view all the answers

    Match the following ankle fracture patterns with their respective characteristics:

    <p>Simple fractures = Nonweight-bearing for 6 weeks Syndesmosis fixation = Nonweight-bearing for 10 weeks Posteromedial variant = Aggressive dorsiflexion post-surgery Atypical patterns = Recognized through CT scans</p> Signup and view all the answers

    What is the typical incidence range of atypical posteromedial variant patterns?

    <p>6%–11% (D)</p> Signup and view all the answers

    The vertical shear pattern in atypical posteromedial variant fractures indicates forced dorsiflexion of the talus within the ankle mortise.

    <p>False (B)</p> Signup and view all the answers

    What is typically done if hardware from a previous surgery becomes symptomatic?

    <p>Remove it not before 9-12 months (C)</p> Signup and view all the answers

    What surgical approach does the author prefer for fixing atypical posteromedial variant patterns?

    <p>Posteromedial approach in the supine position</p> Signup and view all the answers

    Atypical ankle fracture patterns do not require any specific imaging to be diagnosed.

    <p>False (B)</p> Signup and view all the answers

    What is the primary goal of surgical stabilization for ankle fractures?

    <p>atraumatic soft tissue management, rigid internal fixation, and early range of motion exercises</p> Signup and view all the answers

    The fixation of unstable malleolar fractures typically begins with the ______.

    <p>fibula</p> Signup and view all the answers

    Match the following terms with their corresponding descriptions:

    <p>Vertical shear pattern = Indicates forced plantarflexion Double contour sign = Radiographic feature of atypical fracture Posteromedial subluxation = Displacement of the talus Fibular comminution = Results in challenging intraoperative assessment</p> Signup and view all the answers

    What kind of fragment can be observed with higher energy injuries in atypical posteromedial variant patterns?

    <p>Multiple fragments (A), Single fragment (C)</p> Signup and view all the answers

    Posteromedial variant fractures are exclusively associated with high-energy injury mechanisms.

    <p>False (B)</p> Signup and view all the answers

    What is the recommended postoperative protocol for ankle fractures?

    <p>Splint immobilization for 2 weeks</p> Signup and view all the answers

    What is the primary focus of the study by Minihane KP et al. in 2006?

    <p>Comparison of fixation methods for distal fibular fractures (B)</p> Signup and view all the answers

    The dorsal anti-glide plate is primarily used for the treatment of Danis-Weber type A fractures.

    <p>False (B)</p> Signup and view all the answers

    What is the critical concern regarding the placement of the syndesmosis screw?

    <p>Residual syndesmotic instability</p> Signup and view all the answers

    The __________ is an important study that analyzed the effect of plate and screw position on peroneal tendon lesions.

    <p>Weber M, Krause F study</p> Signup and view all the answers

    Match the following techniques or plates with their respective uses:

    <p>Antiglide plate = Danis-Weber type B fractures Lateral locking plate = Osteoporotic bone fractures Syndesmosis screw = Stabilizing syndesmotic injuries Dorsal anti-glide plate = Fixation of lateral malleolar fractures</p> Signup and view all the answers

    Which study provides mechanical considerations for the syndesmosis screw?

    <p>Boden SD et al. 1989 (D)</p> Signup and view all the answers

    Trimalleolar fractures typically do not affect the stability of the talus.

    <p>False (B)</p> Signup and view all the answers

    What is the significance of positioning during syndesmosis screw placement?

    <p>Prevention of residual instability</p> Signup and view all the answers

    What is necessary if a fibula fracture is proximal to the critical transition zone?

    <p>Syndesmosis fixation (B)</p> Signup and view all the answers

    Syndesmotic instability is not a concern in all ankle fracture patterns.

    <p>True (A)</p> Signup and view all the answers

    What is the significance of the medial variant regarding syndesmotic instability?

    <p>Syndesmotic instability may remain despite fixation of the anterior colliculus in case of a medial variant.</p> Signup and view all the answers

    Syndesmotic fixation is required when the __________ ligament is torn, provided medial fixation is not achievable.

    <p>deep deltoid</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Syndesmotic fixation = Used to stabilize an unstable syndesmosis Anterior to posterior screw fixation = Commonly preferred technique for certain fibular fractures Transition zone = Area between 3.0 and 4.5 cm proximal to ankle mortise Residual syndesmotic instability = Condition observed post-fixation in certain fracture patterns</p> Signup and view all the answers

    In a cadaveric model, what percentage of supination-external rotation type IV patterns with a deltoid ligament injury had residual syndesmotic instability?

    <p>39% (A)</p> Signup and view all the answers

    The external rotation stress test is a necessary procedure after all types of ankle fracture fixation.

    <p>False (B)</p> Signup and view all the answers

    What is the primary reason for performing an external rotation stress test in ankle fractures?

    <p>To assess for residual syndesmotic instability post-fixation.</p> Signup and view all the answers

    How much lateral translation of the talus is required to reduce the surface contact area in the ankle joint by 42%, according to a cadaveric study by Ramsey and Hamilton?

    <p>1 mm (A)</p> Signup and view all the answers

    Which of the following structures acts as a primary static stabilizer of the ankle joint and resists external rotation of the talus?

    <p>Deep deltoid ligament (D)</p> Signup and view all the answers

    What is the primary function of the fibula in the context of ankle stability, as discussed in the text?

    <p>Resisting lateral translation of the talus (A)</p> Signup and view all the answers

    What percentage of the tibial articular surface involvement is generally considered a threshold for requiring fixation in a posterior malleolus fracture?

    <p>25% (A)</p> Signup and view all the answers

    Which of the following is NOT a common postoperative protocol for ankle fractures, according to the text?

    <p>Immobilization in a non-weight-bearing cast (C)</p> Signup and view all the answers

    The radiographic sign indicative of a vertical shear pattern in atypical posteromedial variant ankle fractures is:

    <p>Medial clear space widening (B)</p> Signup and view all the answers

    What is the specific technique used to address the posteromedial subluxation of the talus during surgery for atypical posteromedial variant fractures?

    <p>Medial clear space closure with a screw (D)</p> Signup and view all the answers

    Which of the following complications is associated with lateral malleolar plate placement or prominent distal screw heads?

    <p>Peroneal tendon irritation and tendinous lesions. (B)</p> Signup and view all the answers

    What type of plate fixation is preferred for pronation-abduction ankle fractures when fibular length can be restored using the indirect push-pull technique?

    <p>A 3.5-mm reconstruction plate (D)</p> Signup and view all the answers

    What type of fixation is typically recommended for fibular fracture lines immediately proximal to the ankle mortise in a pronation-external rotation ankle fracture?

    <p>A 1/3 tubular plate (C)</p> Signup and view all the answers

    Which of the following is a common consideration for syndesmotic instability in pronation-abduction ankle fractures?

    <p>Lateral tibial plafond impaction (A)</p> Signup and view all the answers

    What is the general rule regarding the minimum size of a posterior malleolar fragment that necessitates fixation?

    <p>Fragments involving 25% or more of the tibial articular surface (A)</p> Signup and view all the answers

    In the context of supination-external rotation fibula fractures, what is the primary rationale for performing an open reduction, as described in the text?

    <p>To allow for the removal of potential soft tissue interposition within the fracture site. (B)</p> Signup and view all the answers

    Why is restoration of fibular length important in the management of a posterior malleolar fracture?

    <p>It indirectly reduces the posterior malleolus (D)</p> Signup and view all the answers

    In a Maisonneuve injury, what is the author's preferred method for restoring fibular length and rotation?

    <p>Plate fixation distal to the fibular neck (A)</p> Signup and view all the answers

    Which of the following statements most accurately reflects the main argument for delaying definitive surgery for ankle fractures for 10-14 days, as described in the text?

    <p>Waiting for definitive surgery allows for the assessment of soft tissue injuries and potential complications. (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the relationship between fibular length restoration and posterior malleolar reduction?

    <p>Restoring fibular length indirectly reduces the posterior malleolus. (A)</p> Signup and view all the answers

    In the context of a pronation-external rotation ankle fracture, what is the rationale for using medial and posterior fixation when possible?

    Signup and view all the answers

    Which of the following elements is NOT a characteristic component of a supination-external rotation (S-ER) injury pattern?

    <p>Avulsion fracture of the lateral malleolus (A)</p> Signup and view all the answers

    The 'combination medial injury variant' described by Tornetta refers to:

    <p>A tension failure of the deep deltoid ligament and an avulsion fracture of the anterior colliculus. (D)</p> Signup and view all the answers

    Which of the following is a characteristic of a pronation-abduction ankle fracture?

    <p>Syndesmotic instability. (D)</p> Signup and view all the answers

    A supination-external rotation type IV pattern with a deltoid ligament injury, following rigid lateral fixation, often results in:

    <p>Residual syndesmotic instability. (C)</p> Signup and view all the answers

    The text mentions a controversial aspect of syndesmosis fixation. What is this controversy mainly focused on?

    <p>The effectiveness of different fixation techniques. (C)</p> Signup and view all the answers

    Which of the following statements accurately describes the preferred method of treating a nondisplaced fibula fracture as described in the text?

    <p>Non-operative management with closed reduction and immobilization. (D)</p> Signup and view all the answers

    The 'push-pull' technique, mentioned as a potential technique for fibular stabilization, is primarily employed to:

    <p>Facilitate a more stable reduction of the fibula fracture. (B)</p> Signup and view all the answers

    When managing a supination-adduction fracture of the fibula, what specific consideration must be made during medial fixation?

    <p>Preventing impingement of soft tissues by hardware. (B)</p> Signup and view all the answers

    What is the recommended placement angle for screw fixation of the syndesmosis?

    <p>30 degrees from posterolateral to anteromedial (B)</p> Signup and view all the answers

    Why is a pelvic clamp considered invaluable in the reduction of the syndesmosis?

    <p>It enables the surgeon to achieve proper alignment of the fibula. (A)</p> Signup and view all the answers

    When treating a pronation-external rotation ankle fracture, how does the choice of fixation method for the fibula depend on the fracture location?

    <p>More proximal fracture lines are better stabilized with a low contact-dynamic compression (LC-DC)-type plate. (C), Fractures immediately proximal to the ankle mortise are better stabilized with a 1/3 tubular plate. (D)</p> Signup and view all the answers

    Based on the provided text, what is the author's preferred method for treating fibular fractures in Maisonneuve injuries?

    <p>Plate fixation distal to the fibular neck for restoration of fibular length and rotation. (C)</p> Signup and view all the answers

    What purpose does a 1.6mm K-wire serve during syndesmosis fixation?

    <p>To prevent translation of the fibula within the incisura fibularis. (C)</p> Signup and view all the answers

    Which fixation technique is preferred to distribute stresses away from the screwhead?

    <p>Using a 2-hole or 3-hole 1/3 tubular plate (C)</p> Signup and view all the answers

    What is the primary rationale for addressing posterior malleolar fragments exceeding 25% involvement of the tibial articular surface?

    <p>Posterior instability leading to talar subluxation and functional impairment. (D)</p> Signup and view all the answers

    What is one of the controversies in syndesmotic fixation techniques?

    <p>Utilization of bioresorbable screws or tendon grafts (D)</p> Signup and view all the answers

    Why is syndesmotic instability anticipated in pronation-abduction ankle fractures specifically?

    <p>The mechanism of injury often involves a lateral force that disrupts the syndesmosis. (A)</p> Signup and view all the answers

    In the context of pronation-external rotation ankle fractures, which of the following correctly describes the rationale for using a reconstruction plate for fracture lines proximal to the ankle mortise?

    <p>Reconstruction plates offer greater stability and stiffness compared to tubular plates for these fractures. (B)</p> Signup and view all the answers

    What is the primary reason for having a low threshold for a medial arthrotomy during syndesmosis fixation?

    <p>To address potential soft tissue interposition due to ligament injuries. (D)</p> Signup and view all the answers

    What is the main reason for the controversy surrounding syndesmosis fixation, based on the provided content?

    <p>The role of syndesmosis fixation in the treatment of ankle fractures remains uncertain, with some surgeons favoring conservative management. (A)</p> Signup and view all the answers

    Based on the provided text, what is the preferred surgical approach for atypical posteromedial variant ankle fracture patterns?

    <p>A combined approach is often necessary to address both the posterior and medial components of the fracture. (D)</p> Signup and view all the answers

    Which of the following scenarios would most likely necessitate syndesmosis fixation, even if the deltoid ligament is intact and medial fixation is possible?

    <p>A fibular fracture proximal to the 4.5 cm transition zone. (E)</p> Signup and view all the answers

    What is the primary rationale for performing an intraoperative external rotation stress test following definitive fracture fixation?

    <p>To assess the integrity of the tibiofibular syndesmosis and guide decisions on syndesmosis fixation, regardless of fracture pattern. (C)</p> Signup and view all the answers

    Which of the following factors might necessitate a medial arthrotomy during syndesmosis fixation?

    <p>An associated deltoid ligament injury, necessitating direct repair or augmentation. (A), A significant posteromedial fracture of the tibia, requiring direct visualization and fixation of the articular surface. (D)</p> Signup and view all the answers

    What is the primary purpose of using a 2-hole or 3-hole 1/3 tubular plate during syndesmosis fixation?

    <p>To facilitate a washer effect laterally, compressing the syndesmotic joint and maintaining fibular length. (C)</p> Signup and view all the answers

    What is the significance of the medial variant, or tension failure of the deep deltoid ligament with an avulsion fracture of the anterior colliculus in relation to syndesmotic instability?

    <p>It highlights the potential for residual syndesmotic instability even after fixation of the anterior colliculus. (C)</p> Signup and view all the answers

    Which of the following options is NOT a factor that may necessitate a medial arthrotomy during syndesmosis fixation?

    <p>A need to assess the integrity of the tibiofibular syndesmosis and guide decisions on syndesmosis fixation, regardless of fracture pattern. (F)</p> Signup and view all the answers

    In the context of syndesmotic fixation, what is the primary function of the K-wire used in the procedure as described in the text?

    <p>To maintain reduction of the fibula fracture while definitive fixation is being placed. (D)</p> Signup and view all the answers

    What is the recommended location for screw fixation of the syndesmosis in relation to the ankle mortise?

    <p>2.0 cm proximal to the ankle mortise (D)</p> Signup and view all the answers

    Which device is primarily used to achieve reduction before implant placement?

    <p>A large pelvic clamp (A)</p> Signup and view all the answers

    What is a common technique used to prevent fibular translation during syndesmosis fixation?

    <p>Placing a K-wire parallel to the syndesmosis (B)</p> Signup and view all the answers

    What angle is recommended for screw fixation trajectory in the axial plane for the syndesmosis?

    <p>30 degrees from posterolateral to anteromedial (A)</p> Signup and view all the answers

    What is a possible rationale for performing a medial arthrotomy during syndesmosis fixation?

    <p>To address incomplete reduction with soft tissue interposition (B)</p> Signup and view all the answers

    What is one of the identified controversies in syndesmotic fixation related to screw options?

    <p>Whether to use 3-cortices or 4-cortices for screw placement (B)</p> Signup and view all the answers

    What specific pattern is associated with atypical posteromedial variant fractures?

    <p>Supination-external rotation pattern (D)</p> Signup and view all the answers

    What is the primary purpose of placing a 3.5mm cortical screw through a 1/3 tubular plate during syndesmosis fixation?

    <p>To distribute stresses away from the screwhead (C)</p> Signup and view all the answers

    What specific feature differentiates syndesmotic fixation in the presence of deltoid ligament injuries?

    <p>The increased need for medial and posterior fixation (D)</p> Signup and view all the answers

    What is the main indication for a CT scan in the context of atypical posteromedial variant fractures?

    <p>Double contour sign observed radiographically (A)</p> Signup and view all the answers

    What is a potential consequence of not restoring fibular length during surgery for atypical posteromedial variant fractures?

    <p>Residual posteromedial subluxation of the talus (C)</p> Signup and view all the answers

    What approach is preferred by the author for addressing the posteromedial variant patterns?

    <p>Posteromedial approach through the posterior tibial tendon sheath (B)</p> Signup and view all the answers

    Which type of fragment variability is seen in posterior malleolus fractures associated with atypical posteromedial variants?

    <p>Single fragment including the entire posterior malleolus (A)</p> Signup and view all the answers

    What postoperative protocol does the author prefer for ankle fractures?

    <p>Splint immobilization for 2 weeks (C)</p> Signup and view all the answers

    What surgical technique is described for addressing talus subluxation during surgery?

    <p>Buttress plate fixation (C)</p> Signup and view all the answers

    What characterizes the fracture pattern efficiency in cases associated with higher energy injuries?

    <p>Increased marginal impaction (C)</p> Signup and view all the answers

    How long must a patient with a syndesmosis fixation remain nonweight-bearing postoperatively?

    <p>10 weeks (C)</p> Signup and view all the answers

    What is emphasized postoperatively for patients with posteromedial variant patterns after surgery?

    <p>Aggressive ankle range of motion (A)</p> Signup and view all the answers

    When should hardware removal be considered for patients with ankle fractures?

    <p>Only if symptomatic and not before 9–12 months (B)</p> Signup and view all the answers

    What is the purpose of serial weight-bearing radiographs postoperatively?

    <p>To monitor bone healing and stability (C)</p> Signup and view all the answers

    What is typically observed in the case of screw loosening or breakage in syndesmosis fixation?

    <p>Increased symptoms of instability (D)</p> Signup and view all the answers

    Which classification system assists surgeons in the management of ankle fractures based on injury patterns?

    <p>Lauge-Hansen classification (C)</p> Signup and view all the answers

    What is the minimum duration for obtaining serial weight-bearing radiographs after surgery for syndesmotic injuries?

    <p>12 months (A)</p> Signup and view all the answers

    What condition may develop due to atypical posteromedial variant patterns if not managed properly?

    <p>Chronic instability of the ankle (B)</p> Signup and view all the answers

    What is the significance of widening of the medial clear space on follow-up radiographs in ankle fractures?

    <p>It signifies the need for surgical intervention. (C)</p> Signup and view all the answers

    Which test is described as being more comfortable for the patient compared to the external rotation stress test?

    <p>Gravity stress test (C)</p> Signup and view all the answers

    What can complicate the diagnosis of deltoid incompetence in ankle fractures?

    <p>Difficulty distinguishing between S-ER II and S-ER IV patterns (D)</p> Signup and view all the answers

    In the absence of an open injury, when can surgical treatment for an unstable ankle fracture pattern typically be performed?

    <p>As an elective procedure (A)</p> Signup and view all the answers

    Which of the following is NOT a predictor of deltoid incompetence according to prior studies?

    <p>Radiographic widening of the medial clear space (B)</p> Signup and view all the answers

    What role do stress radiographs play in the assessment of ankle fractures?

    <p>To evaluate for deltoid incompetence (A)</p> Signup and view all the answers

    What is a common non-surgical approach for managing unstable ankle fractures before surgical intervention?

    <p>Prefabricated fracture boot and weight-bearing (C)</p> Signup and view all the answers

    What is a key consideration when classifying ankle fractures using the Lauge-Hansen classification?

    <p>The mechanism of injury and fracture pattern (C)</p> Signup and view all the answers

    What does the first term in the Lauge-Hansen classification denote?

    <p>The position of the foot (B)</p> Signup and view all the answers

    Which injury pattern constitutes the most frequent type of ankle fracture?

    <p>Supination-external rotation (A)</p> Signup and view all the answers

    Which of the following describes a typical consequence of a supination-external rotation injury?

    <p>Spiral oblique fibula fracture at the ankle mortise (B)</p> Signup and view all the answers

    What is the implication of pronation in the Lauge-Hansen classification?

    <p>The medial structures are on tension (C)</p> Signup and view all the answers

    Which of the following best describes a combination medial injury variant in the context of ankle fractures?

    <p>Tension failure of the deep deltoid ligament with an avulsion fracture (B)</p> Signup and view all the answers

    What is the primary focus of the Lauge-Hansen classification regarding ankle injuries?

    <p>Causative mechanism of injury (D)</p> Signup and view all the answers

    In which year was the Lauge-Hansen classification developed?

    <p>1950 (C)</p> Signup and view all the answers

    What type of injury is associated with the failure of the anterior-inferior tibiofibular ligament in an ankle fracture?

    <p>Supination-external rotation injury (D)</p> Signup and view all the answers

    What is the significance of adhering to A/O principles of internal fixation during ankle surgery?

    <p>It minimizes the risk of infection and enhances stability. (A)</p> Signup and view all the answers

    Which imaging study is important in the preoperative planning of ankle surgeries?

    <p>Computed Tomography (CT) scanning (B)</p> Signup and view all the answers

    How is fibular length and rotation primarily assessed for stability post-surgery?

    <p>Through radiographic analysis off the talofibular articulation. (A)</p> Signup and view all the answers

    What does the indirect 'push-pull' technique accomplish during fibular fracture fixation?

    <p>It allows for anatomical reduction of the fibula with minimal exposure. (D)</p> Signup and view all the answers

    Which general strategy is not used in the restoration of fibular length?

    <p>Early mobilization post-surgery (A)</p> Signup and view all the answers

    What is the purpose of using a simple one-third tubular plate in fibular stabilization for specific injury patterns?

    <p>To provide a low-profile alternative for distal fibular fractures. (C)</p> Signup and view all the answers

    What can be a possible advantage of delaying definitive surgery for 10-14 days in ankle fractures?

    <p>It contributes to better soft tissue conditions, reducing the risk of complications. (D)</p> Signup and view all the answers

    In managing ankle fractures, what primary aspect is assessed radiographically to ensure a stable ankle mortise?

    <p>The restoration of fibular length and rotation. (D)</p> Signup and view all the answers

    What is the primary function of the fibula in the ankle joint?

    <p>Resisting lateral translation of the talus (D)</p> Signup and view all the answers

    A 2 mm lateral translation of the talus can reduce surface contact area in the ankle joint by over 60%.

    <p>True (A)</p> Signup and view all the answers

    What structure acts as a restraint against posterior translation of the talus?

    <p>Posterior malleolus</p> Signup and view all the answers

    Match the ankle fracture types with their corresponding descriptions:

    <p>Pronation-abduction = Involves lateral malleolus, medial malleolus, and syndesmosis Supination-external rotation = Often involves a high fibular fracture, potentially with a Maisonneuve injury Atypical posteromedial variant = Characterized by a vertical shear pattern and posteromedial subluxation of the talus Posterior malleolus fracture = May involve the posterior aspect of the tibial articular surface</p> Signup and view all the answers

    Which of these ankle fracture types is commonly associated with syndesmotic instability?

    <p>Pronation-abduction (B)</p> Signup and view all the answers

    Ankle fractures are always simple, low-energy injuries.

    <p>False (B)</p> Signup and view all the answers

    What is the recommended surgical approach for fixing atypical posteromedial variant patterns, according to the text?

    <p>Posteromedial approach</p> Signup and view all the answers

    In a pronation-abduction ankle fracture, a bridge plate fixation is typically employed.

    <p>True (A)</p> Signup and view all the answers

    Which type of plate is the author's preferred choice for pronation-abduction ankle fractures?

    <p>3.5-mm reconstruction plate (A)</p> Signup and view all the answers

    In a pronation-external rotation ankle fracture, fracture lines immediately proximal to the ankle mortise can be stabilized with a ______ plate.

    <p>1/3 tubular</p> Signup and view all the answers

    What is the primary reason for restoring fibular length in a posterior malleolus fracture?

    <p>Restoring fibular length indirectly reduces the posterior malleolus.</p> Signup and view all the answers

    Match the ankle fracture pattern with the recommended type of plate fixation:

    <p>Pronation-abduction = 3.5-mm reconstruction plate Pronation-external rotation (proximal fracture lines) = 3.5-mm reconstruction plate or LC-DC-type plate Supination-adduction = Hook plate laterally and anti-glide fixation medially</p> Signup and view all the answers

    Which of the following is a technique mentioned in the text for restoring fibular length in a Maisonneuve injury?

    <p>Use of small pointed reduction forceps (A)</p> Signup and view all the answers

    The text provides a definitive threshold for the minimum size of a posterior malleolar fragment requiring fixation.

    <p>False (B)</p> Signup and view all the answers

    What is the primary consideration for syndesmotic fixation in the presence of a deep deltoid ligament tear?

    <p>Syndesmotic instability is anticipated and should be stabilized where necessary.</p> Signup and view all the answers

    Which of these surgical techniques is mentioned in the provided content as an alternative to lateral plate fixation for treating displaced lateral malleolus fractures?

    <p>Antiglide technique (B)</p> Signup and view all the answers

    The use of antiglide plates for fixing lateral malleolar fractures has been found to have no associated complications.

    <p>False (B)</p> Signup and view all the answers

    What percentage of the tibial articular surface involvement in a posterior malleolus fracture is generally considered a threshold for requiring fixation?

    <p>25%</p> Signup and view all the answers

    A ______ ankle fracture variant is characterized by a hyperplantarflexion injury.

    <p>Hyperplantarflexion</p> Signup and view all the answers

    Match the following ankle fracture patterns with their corresponding types of stress tests recommended for evaluating syndesmotic instability:

    <p>Pronation-abduction ankle fractures = External rotation stress test Supination-external rotation type IV patterns = External rotation stress test Atypical posteromedial variant patterns = Not explicitly mentioned in the text</p> Signup and view all the answers

    The gold standard for syndesmosis fixation, as mentioned in the text, is the use of a single, large-diameter screw.

    <p>True (A)</p> Signup and view all the answers

    The supination-adduction (S-AD) pattern accounts for what percentage of ankle fractures?

    <p>10%-20% (B)</p> Signup and view all the answers

    The pronation-abduction (P-AB) pattern is often associated with instability of the syndesmosis.

    <p>True (A)</p> Signup and view all the answers

    What are the three main components of a pronation-external rotation (P-ER) ankle fracture?

    <p>Tension failure of the deep deltoid ligament or transverse avulsion fracture of the medial malleolus, failure of the AITFL, and a spiral oblique fibula fracture above the ankle mortise.</p> Signup and view all the answers

    The presence of a ______ fracture often provides an indirect indication of fibular length.

    <p>posterior malleolar</p> Signup and view all the answers

    Match the ankle fracture pattern with its associated ligament injury:

    <p>Supination-Adduction = Lateral ligament injury Pronation-Abduction = Deep deltoid ligament tear Pronation-External Rotation = AITFL failure</p> Signup and view all the answers

    In which ankle fracture pattern is an impaction injury to the lateral tibial plafond commonly observed?

    <p>Pronation-Abduction (C)</p> Signup and view all the answers

    The Maisonneuve injury is associated with the pronation-external rotation (P-ER) pattern of ankle fracture.

    <p>True (A)</p> Signup and view all the answers

    What radiographic criteria help assess the stability of a malleolar fracture?

    <p>Coronal plane symmetry with respect to the medial and lateral clear spaces, preservation of fibular length, and the presence or absence of a posterior malleolar fracture.</p> Signup and view all the answers

    Which of the following studies investigated the effect of fibular malreduction on contact pressures in an ankle fracture malunion model?

    <p>Thordarson DB, Motamed S, Hedman T, et al.The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.J Bone Joint Surg Am 1997;79:1809–15. (C)</p> Signup and view all the answers

    The text suggests that delaying definitive surgery for ankle fractures by 10-14 days can help to reduce the risk of some complications.

    <p>True (A)</p> Signup and view all the answers

    The text suggests that obtaining medial and posterior fixation may _____ wound healing and promote _____ union.

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    Which of the following studies focuses specifically on the effect of fibular malreduction on contact pressures in an ankle fracture malunion model?

    <p>Thordarson DB, Motamed S, Hedman T, et al.The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.J Bone Joint Surg Am 1997;79:1809–15. (C)</p> Signup and view all the answers

    Syndesotic instability is anticipated in pronation-abduction ankle fractures.

    <p>True (A)</p> Signup and view all the answers

    The ______ stress view can be used for diagnosing deltoid injury in ankle fractures.

    <p>gravity</p> Signup and view all the answers

    Match the following types of ankle fractures to the primary mechanism of injury described in the text:

    <p>Pronation-abduction = Involves a forceful external rotation of the foot and ankle, leading to an avulsion fracture of the fibula and possible medial ligament injury Supination-external rotation = Characterized by a forceful dorsiflexion and external rotation of the foot, resulting in an avulsion fracture of the fibula and potential syndesmosis injury Supination-adduction = Occurs when the foot is forced into dorsiflexion and inversion, often resulting in a transverse fracture of the fibula and potential deltoid ligament injury</p> Signup and view all the answers

    What are the two primary factors considered when classifying an ankle fracture using the Lauge-Hansen classification?

    <p>The mechanism of injury and the radiographic fracture pattern. (C)</p> Signup and view all the answers

    Medial tenderness, swelling, and ecchymosis are reliable indicators of deltoid incompetence in ankle fractures.

    <p>False (B)</p> Signup and view all the answers

    What type of radiographic stress test involves positioning the ankle with the lateral portion down on the table, while the majority of the ankle is off the edge?

    <p>Gravity stress test</p> Signup and view all the answers

    In the absence of an open injury or an irreducible dislocation, surgical treatment for an unstable ankle fracture pattern is not an ______.

    <p>emergency</p> Signup and view all the answers

    Match the following ankle fracture patterns with their corresponding Lauge-Hansen classifications:

    <p>Pronation-abduction = S-ER II Pronation-external rotation = S-ER IV Supination-adduction = P-A Supination-external rotation = P-ER</p> Signup and view all the answers

    The gravity stress test is generally considered more comfortable for patients than the external rotation stress test.

    <p>True (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of atypical posteromedial variant ankle fracture patterns?

    <p>Lateral malleolar fracture (B)</p> Signup and view all the answers

    What radiographic sign indicates a vertical shear pattern in atypical posteromedial variant ankle fractures?

    <p>Posterior subluxation of the talus</p> Signup and view all the answers

    Restoring fibular length and rotation is crucial for achieving a stable ankle mortise.

    <p>True (A)</p> Signup and view all the answers

    Which of the following techniques is used to restore fibular length in indirect reduction, as described in the text?

    <p>All of the above (D)</p> Signup and view all the answers

    The text advocates for using a ______ plate with ______ screws for fibular stabilization in a supination-external rotation ankle fracture.

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    In a pronation-abduction ankle fracture, what type of plate fixation is typically employed?

    <p>Bridge plate (D)</p> Signup and view all the answers

    A Maisonneuve injury is a type of pronation-external rotation ankle fracture involving a fracture of the fibula proximal to the ankle mortise.

    <p>True (A)</p> Signup and view all the answers

    Fragments involving ______% or more of the tibial articular surface are generally considered to require fixation in a posterior malleolar fracture.

    <p>25</p> Signup and view all the answers

    Which of these patterns is the lone indication for a locking plate in ankle fractures?

    <p>Pronation-abduction (B)</p> Signup and view all the answers

    Match the following ankle fracture patterns with their corresponding primary fixation methods:

    <p>Pronation-abduction = Bridge plate Pronation-external rotation (distal to fibular neck) = Reconstruction plate Pronation-external rotation (immediately proximal to ankle mortise) = 1/3 tubular plate Maisonneuve injury = Plate fixation Posterior malleolus fragment &gt; 25% of tibial articular surface = Stabilization (fixation)</p> Signup and view all the answers

    Syndesmotic instability is NOT anticipated in a pronation-abduction ankle fracture.

    <p>False (B)</p> Signup and view all the answers

    What is the rationale for restoring fibular length in a posterior malleolar fracture?

    <p>Indirect reduction of the posterior malleolus</p> Signup and view all the answers

    For simple ankle fracture patterns, how long does the patient remain nonweight-bearing postoperatively?

    <p>6 weeks (C)</p> Signup and view all the answers

    The author recommends routine removal of hardware for ankle fractures unless it is causing discomfort.

    <p>False (B)</p> Signup and view all the answers

    What specific type of ankle fracture pattern requires the patient to remain nonweight-bearing for 10 weeks postoperatively?

    <p>Fracture patterns requiring syndesmosis fixation</p> Signup and view all the answers

    The goal of surgical stabilization for ankle fractures includes atraumatic soft tissue management, rigid internal fixation, and ______.

    <p>early range of motion exercises</p> Signup and view all the answers

    Match the following types of ankle fracture patterns with their corresponding nonweight-bearing periods:

    <p>Simple patterns = 6 weeks Syndesmosis fixation = 10 weeks Posteromedial variant patterns = 10 weeks</p> Signup and view all the answers

    Which of the following imaging modalities is specifically recommended for evaluating atypical posteromedial variant fractures?

    <p>CT scan (A)</p> Signup and view all the answers

    The author emphasizes aggressive ankle range of motion exercises after surgery, particularly for posteromedial variant patterns.

    <p>True (A)</p> Signup and view all the answers

    What specific technique is employed to address the posteromedial subluxation of the talus during surgery for atypical posteromedial variant patterns?

    <p>A posterior approach with a bone graft and screw fixation</p> Signup and view all the answers

    What is the gold standard for syndesmosis fixation?

    <p>Screw fixation (C)</p> Signup and view all the answers

    A medial arthrotomy is always necessary for reduction of the syndesmosis.

    <p>False (B)</p> Signup and view all the answers

    What type of screw is recommended for syndesmosis fixation?

    <p>Position screws</p> Signup and view all the answers

    The optimum location for syndesmotic screw fixation is ____ cm proximal to the ankle mortise.

    <p>2.0</p> Signup and view all the answers

    The author always uses a medial arthrotomy for the purpose of syndesmosis fixation.

    <p>False (B)</p> Signup and view all the answers

    What is the preferred type of plate used for syndesmosis fixation according to the author?

    <p>A 2-hole or 3-hole 1/3 tubular plate</p> Signup and view all the answers

    Which of the following is NOT a common complication associated with the use of antiglide plates for lateral malleolar fractures?

    <p>Osteonecrosis (D)</p> Signup and view all the answers

    The 'push-pull' technique mentioned in the text is primarily used for treating fibular fractures with excessive comminution.

    <p>True (A)</p> Signup and view all the answers

    What is the recommended method for restoring fibular length and rotation in a pronation-abduction ankle fracture?

    <p>A lateral plate fixation is typically employed to restore fibular length and rotation in a pronation-abduction ankle fracture.</p> Signup and view all the answers

    The text mentions that a deep deltoid ligament tear with a ______ fracture of the anterior colliculus is a medial variant that indicates the presence of a tension failure.

    <p>avulsion</p> Signup and view all the answers

    Match the following ankle fracture types with their typical plate fixation methods:

    <p>Pronation-abduction = Lateral plate Supination-external rotation = Dorsal anti-glide plate Supination-adduction = Lateral neutralization plate Posterior malleolar fractures = May require fixation depending on articular surface involvement</p> Signup and view all the answers

    The 'gold standard' for syndesmosis fixation involves a two-hole or three-hole 1/3 tubular plate for a washer effect laterally.

    <p>True (A)</p> Signup and view all the answers

    In the context of the provided content, what is the typical range of incidence for atypical posteromedial variant ankle fracture patterns?

    <p>The provided text does not explicitly state the typical incidence of atypical posteromedial variant ankle fracture patterns.</p> Signup and view all the answers

    The "push-pull" technique is primarily used for open reduction of fibular fractures

    <p>False (B)</p> Signup and view all the answers

    What is the primary function of the A/O laminar spreader in the "push-pull" technique?

    <p>It helps to restore fibular length and reduce the fracture.</p> Signup and view all the answers

    The presence of ______ tenderness often indicates a deep deltoid ligament incompetence.

    <p>medial</p> Signup and view all the answers

    Match the following ankle fracture types with their corresponding descriptions:

    <p>Pronation-abduction = Involves a lateral malleolus fracture, a medial malleolus fracture, and a syndesmosis injury Supination-external rotation = Involves fracture of the lateral malleolus and potentially the fibula proximal to the ankle joint Atypical Posteromedial Variant = Characterized by posteromedial subluxation of the talus, often accompanied by a vertical shear fracture of the medial malleolus and/or posterior tibial articular surface Maisonneuve injury = Involves a fracture of the fibula proximal to the ankle joint and a syndesmotic injury</p> Signup and view all the answers

    Which of the following is a potential complication associated with prominent distal screw heads in lateral malleolar plate placement?

    <p>Soft tissue irritation (D)</p> Signup and view all the answers

    A non-displaced fibula fracture is routinely treated with surgical fixation according to this text.

    <p>False (B)</p> Signup and view all the answers

    What must be restored to ensure a stable ankle mortise?

    <p>Fibular length and rotation (A)</p> Signup and view all the answers

    The use of rigid internal fixation is not essential for a favorable functional outcome in extremity fractures.

    <p>False (B)</p> Signup and view all the answers

    What imaging study may be completed during the delay before definitive surgery?

    <p>Computed tomography (CT) scanning</p> Signup and view all the answers

    Restoration of fibular length and rotation can be assessed radiographically off of the __________ articulation.

    <p>talofibular</p> Signup and view all the answers

    Match the following surgical techniques with their descriptions:

    <p>Dorsal anti-glide = Used for fibular stabilization in supination-external rotation fractures Lateral neutralization = Another technique for fibular stabilization in external rotation injuries Indirect push-pull = Technique for restoring fibular length with a plate A/O laminar spreader = Instrument used to aid in fibular length restoration under fluoroscopy</p> Signup and view all the answers

    What is a common method to minimize periosteal stripping during surgical intervention?

    <p>Atraumatic soft tissue handling (B)</p> Signup and view all the answers

    Early range of motion is discouraged in internal fixation practices.

    <p>False (B)</p> Signup and view all the answers

    What is the primary goal of delaying surgery for 10-14 days in ankle fractures?

    <p>To allow resolution of the acute inflammatory phase and reduce soft tissue swelling</p> Signup and view all the answers

    Flashcards

    Delay in Surgery

    Waiting 10-14 days before performing surgery to allow inflammation reduction.

    Soft Tissue Management

    Handling soft tissues atraumatically during fixation is crucial for recovery.

    Anatomic Fracture Reduction

    Realigning the fractured bone to its normal anatomical position.

    Rigid Internal Fixation

    Using strong materials to hold the fractured bones in place securely.

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    Early Range of Motion

    Encouraging movement soon after surgery to improve recovery.

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    Fibular Length Restoration

    Critical process to ensure proper alignment of the ankle after fracture.

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    Indirect Reduction Techniques

    Method used to restore fibular length when fractures are complex or bone quality is poor.

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    Supination-External Rotation Injury

    A specific ankle injury pattern that requires tailored stabilization techniques.

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    Dorsal anti-glide plate

    A fixation method for fractures that provides strong support and better soft tissue coverage.

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    Fracture healing rates

    The speed at which fractures repair and restore their original state.

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    Peroneal tendon irritation

    Discomfort or injury to the peroneal tendons associated with improper plate placement.

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    Open reduction

    A surgical approach that allows for direct access to the fracture site to minimize complications.

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    Minimally displaced fractures

    Fractures that are not significantly shifted from their original position.

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    Lag screw fixation

    A technique that stabilizes bone fragments by compressing them together using screws.

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    Bone graft substitute

    Materials used to fill defects in bones and support healing when natural bone isn't available.

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    Displaced fragments

    Bone segments that have moved from their normal alignment due to fracture.

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    Screw Fixation

    Current gold standard method for syndesmotic stabilization using screws.

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    Pelvic Clamp

    A tool used to obtain reduction of the syndesmosis before implant placement.

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    K-wire in Syndesmosis

    A 1.6mm K-wire helps prevent fibula translation during clamping.

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    Optimum Screw Location

    Place screws 2.0cm proximal to the ankle mortise at a 30-degree angle.

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    Medial Arthrotomy

    Procedure to improve reduction in cases of deltoid ligament injury.

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    Cortical Screw Sizes

    Debate exists over using 3.5mm, 4.0mm, or 4.5mm screws for fixation.

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    External-Rotation Stress Test

    Test performed before and after implant placement for ankle stability.

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    Controversies in Syndesmotic Fixation

    Debates on fixation methods, screw counts, and removal timing.

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    Atypical Posteromedial Variants

    Fracture patterns associated with ankle injuries, occurring in 6%-11% of cases.

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    Forced Plantarflexion

    An ankle movement causing the talus to rotate externally, leading to specific fractures.

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    Vertical Split Pattern

    A fracture that runs vertically through the posterior malleolus, often seen in posteromedial variants.

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    Double Contour Sign

    Radiographic indication of a vertical shear pattern, important for diagnosis.

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    Posteromedial Subluxation

    A condition where the talus is partially displaced posteriorly and medially due to fracture patterns.

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    Posteromedial Approach

    Surgical technique for accessing the ankle through the posterior tibial tendon sheath.

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    Buttress Plate Fixation

    Stabilization method used to correct posteromedial subluxation, restoring fibular length.

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    Postoperative Splint Immobilization

    Recommended for 2 weeks after ankle surgery to promote healing and stability.

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    Maisonneuve Injury Fixation

    A method of stabilizing a Maisonneuve injury utilizing medial and posterior fixation along with a tubular plate.

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    Syndesmotic Instability

    A condition where the stability of the syndesmosis is compromised, often requiring surgical intervention.

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    Transition Zone

    A specific area between 3.0 and 4.5 cm above the ankle where syndrome fixation criteria may change.

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    Deltoid Ligament Tear

    Injury to the deltoid ligament, affecting syndesmotic stability based on the fracture location.

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    Intraoperative Stress Test

    A procedure performed during surgery to assess for residual syndesmotic instability post-fixation.

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    Residual Syndesmotic Instability

    Remaining instability in the syndesmosis after treatment, which may require further interventions.

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    S-ER IV Pattern

    A classification of ankle injury that poses specific risks for syndesmotic instability.

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    Tension Failure

    The condition in which the deltoid ligament fails under stress, contributing to syndesmotic instability.

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    Pronation-Abduction

    An ankle fracture pattern requiring bridge plate fixation due to lateral comminution.

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    Bridge Plate Fixation

    A surgical method to stabilize complex ankle fractures using a metal plate applied across.

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    Maisonneuve Injury

    A fracture pattern where fibular length and rotation can be restored, often requiring plate fixation.

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    Posterior Malleolar Fragments

    Small pieces of bone in the posterior malleolus that may require fixation if large enough.

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    Fibular Fixation Techniques

    Various methods to stabilize the fibula based on fracture location.

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    Tibial Articular Surface

    The weight-bearing surface of the tibia that can be affected by fractures.

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    Reconstruction Plate

    A specific type of surgical plate used to stabilize fractures and restore anatomy.

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    Lauge-Hansen Classification

    A system categorizing ankle fractures based on injury mechanisms identified in 1950.

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    Supination-External Rotation (S-ER) Pattern

    The most common ankle fracture type, accounting for 40%-75% of cases.

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    Anterior-Inferior Tibiofibular Ligament (AITFL)

    A ligament that may fail in supination-external rotation injuries.

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    Posterior-Inferior Tibiofibular Ligament (PITFL)

    A ligament that may be injured with S-ER ankle fractures.

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    Deep Deltoid Ligament

    A ligament that can experience tension failure during supination-external rotation injuries.

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    Combination Medial Injury

    Involves tension failure of the deep deltoid ligament and avulsion of the anterior colliculus in ankle fractures.

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    Avulsion Fracture

    A fracture occurring when a ligament or tendon pulls off a piece of bone.

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    Stability Stages in Fractures

    Subdivisions in Lauge-Hansen classification indicating injury stability levels.

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    Atypical Posteromedial Variant Patterns

    Fracture patterns in ankle injuries ranging from 6%-11%, linked to different injury mechanisms.

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    Syndesmotic Screw

    A screw used for stabilizing syndesmosis in ankle fractures.

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    Trimalleolar Fractures

    Fractures involving three malleolar areas of the ankle.

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    Hyperplantarflexion Variant

    A specific ankle fracture variant due to extreme plantarflexion.

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    Antiglide Technique

    Surgical method for fixing displaced lateral malleolus fractures.

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    Peroneal Tendon Lesions

    Injuries to tendons caused by improper fixation plate placement.

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    Biomechanical Analysis

    Study examining the mechanical properties of fixation techniques.

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    Ankle Fracture

    A common injury affecting the ankle joint resulting from a fall or twist.

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    Malleolus

    The bony prominence on either side of the ankle joint.

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    Joint Congruency

    The alignment of joint surfaces that ensures contact area during movement.

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    Contact Forces

    The forces shared between the joint surfaces during activities like walking.

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    Post-Traumatic Arthritis

    Arthritis that develops after an injury, particularly from joint incongruities.

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    Talus

    The ankle bone that sits above the heel and below the tibia and fibula.

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    Deltoid Ligament

    A stabilizing ligament located on the medial side of the ankle, preventing excessive movement.

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    Lateral Translation

    The sideways movement of the talus that can reduce the contact area in the ankle joint.

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    Acute Inflammatory Phase

    The early stage of inflammation typically lasting 10–14 days after injury.

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    Soft Tissue Envelope

    The surrounding soft tissues that protect the ankle joint during surgery.

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    A/O Principles of Internal Fixation

    Guidelines to follow for stable fracture treatment, including proper soft tissue handling and fixation.

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    Radiographic Assessment

    Using imaging techniques like X-rays to evaluate fibular length and rotation after a fracture.

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    Indirect 'Push-Pull' Technique

    A method used to restore fibular length by applying controlled forces during surgery.

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    Dorsal Anti-Glide Technique

    A stabilization method using a specific plate setup to secure fibular fractures.

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    Lateral Neutralization Technique

    A stabilization approach for fibular fractures, typically using a tubular plate.

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    Fluoroscopic Guidance

    Using real-time imaging during surgery to assist in restoring fibular alignment.

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    Supination-Adduction Pattern

    Ankle fracture pattern involving a low avulsion fracture of the lateral malleolus and a vertical shear fracture of the medial malleolus.

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    Pronation-Abduction Pattern

    Ankle fracture pattern involving tension failure of the deep deltoid ligament and a transverse fibula fracture.

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    Pronation-External Rotation Pattern

    Ankle fracture pattern with failure of the deep deltoid ligament and a spiral oblique fibula fracture.

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    Medial Malleolus Injury

    Injury pattern in ankle fractures involving the medial malleolus, often related to avulsion or transverse fractures.

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    Lateral Tibial Plafond Impact Injury

    Fracture pattern associated with impact injuries in the lateral tibial plafond from specific ankle fracture mechanisms.

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    Coronal Plane Symmetry

    Radiographic assessment criterion for ankle fractures, indicating stability based on symmetry between medial and lateral clear spaces.

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    Shenton’s Line of the Ankle

    An indicator of inherent stability in ankle fractures assessed through radiographic alignment of the fibula.

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    Biomechanical Considerations

    Factors affecting the forces and stability at the ankle joint during movement.

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    Delay before Surgery

    Postponing surgery for 10-14 days to allow inflammation to reduce and improve outcomes.

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    Supination-External Rotation Pattern

    Most common ankle fracture type related to specific movement mechanisms.

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    Nonweight-bearing Period

    Duration post-surgery where the patient must not put weight on the limb.

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    Serial Radiographs

    X-rays taken at intervals to monitor healing and assess fracture alignment.

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    Removal of Hardware

    Typically done only if symptomatic, not before 9-12 months after surgery.

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    Syndesmosis Fixation

    Stabilizing injury at the syndesmosis, often necessitating surgery.

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    Ankle Dorsiflexion

    Movement of the ankle that brings the toes towards the shin, important in recovery.

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    Optimal Screw Placement

    Screws should be placed 2.0 cm proximal to the ankle mortise at a 30-degree angle.

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    Role of Pelvic Clamp

    Used to obtain syndesmosis reduction before implant placement.

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    K-Wire Functionality

    A 1.6mm K-wire prevents fibula translation during pelvic clamp application.

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    Medial Arthrotomy Indication

    Performed to improve reduction in cases with deltoid ligament injury.

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    Screw Fixation Debate

    Controversies exist over screw sizes and numbers for syndesmotic fixation.

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    Importance of Soft Tissue Management

    Atraumatic handling of soft tissues is crucial for healing post-fixation.

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    Controversies in Fixation

    Various debates regarding methods and timing of syndesmotic fixation.

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    Posterior Malleolar Fractures

    Fractures affecting small bone pieces in the posterior malleolus.

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    Indication for Locking Plates

    Bridge plate fixation may be the only scenario in ankle fractures for using a locking plate.

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    Impaction Injury

    Injury to either the medial or lateral tibial plafond associated with certain ankle fractures.

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    Residue Posteromedial Subluxation

    Residual displacement of the talus after failure to restore fibular length properly.

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    Postoperative Protocols

    Splint immobilization recommended for 2 weeks after ankle surgery to promote healing.

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    Postoperative Nonweight-bearing Period

    Duration where the patient should avoid putting weight on the limb.

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    Serial Weight-bearing Radiographs

    X-rays taken periodically to monitor bone healing after surgery.

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    Aggressive Ankle Range of Motion

    Promoting ankle movement as recovery progresses, especially dorsiflexion.

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    Hardware Removal Timing

    Surgical screws or hardware typically removed 9–12 months post-op if symptomatic.

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    Danis-Weber Type B Fracture

    A specific classification of the lateral malleolus fracture often treated with surgical techniques.

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    Biomechanical Study

    Research examining how different fixation methods affect the stability and strength of bone healing.

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    Mechanical Considerations

    Factors impacting the forces and stability at the ankle during movement and recovery.

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    Fibula Fixation Options

    Various methods to stabilize the fibula depending on fracture type and displacement.

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    Screw Fixation Method

    Gold standard for syndesmotic stabilization using screws placed as position screws.

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    Pelvic Clamp Purpose

    A device used to achieve reduction of the syndesmosis prior to placement of implants.

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    K-Wire Placement

    A 1.6mm K-wire placed to prevent fibula translation during pelvic clamp use.

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    Optimum Screw Angle

    Screws should be positioned 2.0 cm above the ankle mortise at a 30-degree angle.

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    Medial Arthrotomy Reason

    Surgical procedure to help with reduction when there's a deltoid ligament injury.

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    Syndesmosis Controversies

    Debates about methods, screw sizes, and timing for syndesmotic fixation.

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    Cortical Screw Size Debate

    Discussion on using 3.5mm, 4.0mm, or 4.5mm screws for optimal fixation.

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    Failure of the Posterior-Inferior Tibiofibular Ligament (PITFL)

    A common injury in supination-external rotation fractures, leading to instability.

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    Injury Patterns

    Different classifications of ankle injuries categorized by their mechanism of force and result.

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    Ankle Fracture Evaluation

    Initial assessment includes patient history and injury mechanism.

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    Stable vs Unstable Injury Patterns

    Stable injuries may be treated nonoperatively; unstable injuries require surgery.

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    Deltoid Incompetence Diagnosis

    Medial tenderness and swelling are poor predictors of deltoid incompetence.

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    Stress Radiographs

    Used to assess deltoid incompetence when standard imaging is inconclusive.

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    Gravity Stress Test

    A method to assess deltoid ligament integrity by noting medial space widening.

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    Operative Treatment Indication

    Required if medial clear space widens on follow-up radiographs after nonoperative management.

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    Elective Surgery Timing

    Surgical treatment of unstable fractures is not usually an emergency.

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    Delay in Surgery Benefits

    Allows soft tissue swelling reduction before surgery, reducing complications.

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    A/O Principles

    Guidelines necessary for stable internal fixation of fractures, ensuring optimal recovery.

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    Fibular Rotation Restoration

    Essential for stabilizing the ankle joint and can be assessed through imaging techniques.

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    Supination-External Rotation Significance

    Most common type of ankle fracture related to specific injury scenarios.

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    Elastic Compression Stocking

    A stocking used to provide support and reduce swelling after limb surgery.

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    Removal of Hardware Timing

    Generally, hardware is not removed until 9-12 months post-surgery unless symptomatic.

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    Syndesmotic Screw Fixation

    A surgical technique using screws to stabilize the syndesmosis after an ankle injury.

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    Pelvic Clamp Usage

    A tool to achieve reduction of the syndesmosis prior to screw placement in ankle surgery.

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    Patient Weight-Bearing Restrictions

    Guidelines determining when a patient can start bearing weight after ankle surgery.

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    K-wire Placement in Syndesmosis

    Using a 1.6mm K-wire to prevent fibula movement during syndesmosis clamping.

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    Optimum Screw Trajectory

    Screws should be placed 2.0 cm above the ankle mortise at a 30-degree angle.

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    Medial Arthrotomy Purpose

    A surgical procedure to enhance reduction in syndesmosis injuries, especially with deltoid ligament tears.

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    Controversies in Fixation Methods

    Ongoing debates about screw size and fixation techniques for syndesmosis stabilization.

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    Vertical Shear Fracture

    Fracture pattern characterized by vertical splits through the bone, often seen in ankle injuries.

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    Gravity Stress View

    A radiographic technique to assess deltoid injury in ankle fractures.

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    Supination-External Rotation (S-ER) Injury

    The most common type of ankle fracture, involving specific mechanisms of injury.

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    Deltoid Ligament Assessment

    Evaluating the integrity of the deltoid ligament after an ankle fracture.

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    Manual Stress Examination

    A clinical test used to evaluate fibular fractures post-injury.

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    Ankle Joint Congruency

    The alignment of joint surfaces ensuring stable contact during movement.

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    Fibular Malreduction Effects

    Impact on contact pressures in ankle fractures due to improper fibular alignment.

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    Medial Clear Space Widening

    An indication of deltoid incompetence noted in follow-up radiographs.

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    Operative Treatment Timing

    Surgical treatment for unstable fractures can be elective, not emergency.

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    Follow-Up Radiographs

    X-rays taken days after an injury to monitor injury progression.

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    Fibular Length and Rotation Restoration

    Critical adjustments to ensure proper alignment of the ankle after fracture.

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    Syndesmosis Reduction Technique

    A 1.6mm K-wire prevents fibula translation during pelvic clamp application.

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    Medial Arthrotomy Use

    Procedure to improve reduction in cases of deltoid ligament injury.

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    Importance of Stress Testing

    An external-rotation stress test checks ankle stability post-fixation.

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    Postoperative Nonweight-bearing

    Patients must not put weight on the limb for a specified duration post-surgery.

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    Syndesmosis Fixation Timing

    Screws used for syndesmosis fixation should typically not be removed before 12 months unless symptomatic.

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    Early Range of Motion Exercises

    Exercises started early post-surgery to improve recovery and ankle function.

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    Fracture Boot Use

    An elastic compression stocking and boot are used to protect the limb post-fracture.

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    Aggressive Ankle Dorsiflexion

    Emphasized movement called for in specific fracture recovery, particularly in posterior injuries.

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    Tibiotalar Contact Area

    The surface area where the tibia and talus meet, crucial for ankle stability.

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    Fibular Malreduction

    Improper alignment of the fibula during fracture healing affecting joint pressure.

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    Deltoid Ligament Competence

    The ability of the deltoid ligament to maintain stability after ankle fractures.

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    Marginal Plafond Impaction

    A fracture complication associated with lateral malleolar injuries that can impact joint surfaces.

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    Study Notes

    Ankle Fractures: A Rational Approach

    • Ankle fractures are among the most common fractures, often resulting from lower-energy, rotational injuries.
    • Unlike pilon fractures, ankle fractures have a lower inherent incidence of post-traumatic arthritis.
    • Ankle fractures represent a range of injury severity, from simple to complex.
    • The ankle joint experiences significant forces, up to 1.5 times body weight during gait, and exceeding 5.5 times body weight during strenuous activity.

    Biomechanical Considerations

    • Ankle joint congruency is critical for long-term ankle viability.
    • Even a 1mm lateral talus translation can reduce ankle joint surface contact area by 42%. A 2mm translation reduces contact by 64%.
    • Reduced surface contact leads to abnormal joint stress, potentially causing post-traumatic arthritis.
    • Fibular shortening or external rotation increases contact forces and may predispose the ankle to arthritis.
    • The fibula acts as a post to resist lateral translation, the posterior malleolus resists posterior talus translation, and fractures involving 25% or more of the articular surface can lead to posterior instability.
    • The medial malleolus, anchoring the deep deltoid ligament, is a primary static stabilizer resisting external talus rotation.

    Classification of Ankle Fractures

    • The Lauge-Hansen classification (1950) categorizes ankle fractures based on the mechanism of injury.
    • Four consistent patterns exist: supination-external rotation, supination-adduction, pronation-abduction, and pronation-external rotation.
    • Each pattern is subdivided into stages to assess injury stability.
    • The first term describes the foot's position, the second the direction of force.

    Injury Patterns

    • Supination-external rotation (S-ER) is the most common pattern (40-75%):

      • Failure of the anterior-inferior tibiofibular ligament (AITFL)
      • Spiral oblique fibula fracture
      • Failure of the posterior-inferior tibiofibular ligament (PITFL) or posterior malleolus fracture.
      • Deep deltoid ligament failure or transverse avulsion fracture of the medial malleolus.

    • Supination-adduction involves a low lateral malleolar avulsion fracture or lateral ligament injury, and/or vertical shear fracture of the medial malleolus, often associated with medial tibial plafond impaction.

    • Pronation-abduction fractures often involve deep deltoid ligament failure, AITFL and PITFL failure, and sometimes a transverse fibula fracture with lateral comminution.

    • Pronation-external rotation includes Maisonneuve injury with deep deltoid ligament failure, AITFL failure, a spiral oblique fibula fracture above the ankle mortise, and possible PITFL or posterior malleolus fracture.

    Radiographic Considerations

    • Radiographic assessment aids in determining injury stability.
    • Coronal plane symmetry, particularly in the absence of medial fractures, is evaluated. Preservation of fibular length and “Shenton's line” suggest inherent stability.
    • Sagittal plane should be evaluated, assessing posterior malleolar status as this provides an indication of fibular length.
    • Radiographic criteria help assess injury stability (e.g., medial and lateral clear spaces).
    • Stress radiographs (e.g., external rotation, gravity tests) are beneficial for assessing deltoid ligament or syndesmotic instability. Different types of stress tests are possible, such as an external rotation test, or a gravity test.

    Decision-Making and Operative Treatment

    • Clinical evaluation prioritizes patient history, injury mechanism, and radiographic findings for accurate classification according to Lauge-Hansen.
    • Stable injury patterns often permit non-operative treatment.
    • Unstable patterns usually require operative treatment, typically after a 10-14 days delay.
    • Surgical treatment aims for restoring fibular and malleolar length and rotation via direct or indirect reduction techniques. Plates, screws, and other implants are used. Specific techniques are outlined for different patterns of fracture, including posteromedial and atypical patterns. Operative techniques are outlined for different patterns of fracture, including posteromedial and atypical patterns. Techniques like the gravity test and external rotation stress test help to identify syndesmotic instability. Specific considerations include techniques for posteromedial fractures (e.g., posterolateral approach, buttress plating).
    • Operative fixation may be determined by the size of the fragment or the amount of displacement. Specific techniques are outlined for supination-external rotation, supination-adduction, pronation-adduction, and pronation-external rotation. Specific considerations exist for fixation and treatment for atypical fracture patterns.
    • Atypical posteromedial fractures, characterized by vertical shear through the posterior colliculus, may necessitate specific approaches.
    • Certain fracture patterns (e.g., posteromedial, high-energy) may involve significant posterior instability requiring additional fixation and longer non-weight bearing periods.

    Postoperative Protocols

    • Post-operative immobilization (e.g., splint or boot) with subsequent weight-bearing progression is crucial.
    • Patients undergo regular follow-up for stability assessment and possible hardware removal. Non-weightbearing periods and follow up requirements may vary by type of fracture or treatment.

    Complications and Variants

    • Syndesmotic instability is a significant consideration in certain fracture patterns.
    • Atypical posteromedial fracture patterns may require tailored assessment and treatment approaches, sometimes requiring CT scans for detailed evaluation.
    • Fixation of unstable malleolar fractures often begins with the fibula, but posteromedial variants may present challenges due to talus subluxation.
    • Specific considerations exist for posteromedial fractures, such as the posterolateral approach and buttress plating techniques.
    • Patient weight-bearing restrictions (e.g., 10 weeks) often vary depending on the specific fracture pattern and treatment.
    • The Lauge-Hansen classification may not apply to all fracture patterns. For example, atypical posteromedial fracture patterns.

    Additional Considerations

    • Specific considerations for fixation and treatment exist for atypical fracture patterns, particularly those involving the posterior malleolus.
    • Operative techniques and decision-making are detailed regarding unstable fractures, syndesmosis fixation, and atypical posteromedial patterns.
    • The presence of certain radiographic signs (e.g., double contour sign) may indicate atypical posteromedial patterns.
    • Possible surgical intervention (e.g., posteromedial approach, buttress plate placement) and timing of weight-bearing after surgery are discussed.
    • There are ongoing controversies regarding the best methods of syndesmotic fixation (e.g., screw placement, bone graft).
    • Special attention is paid to the depth of the fracture and the type of fixating method utilized.
    • Specific fixation techniques (e.g., hook plates, single screws, tension bands) are described.
    • A review of controversies associated with syndesmotic fixation is included.

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    Related Documents

    A Rational Approach to Ankle Fractures PDF
    A Rational Approach to Ankle Fractures PDF

    Description

    This quiz explores the significance of biomechanical considerations in ankle fractures, including injury severity and joint congruency. Understand how forces during activities affect the ankle joint and the implications for post-traumatic arthritis. Test your knowledge on key concepts related to ankle health.

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