Ankle Fractures I PDF

Ankle Fractures I Allen J Kempf, DPM, MS, FACFAS, DABPM Assistant Professor College of Podiatric Medicine and Surgery Des Moines University Objectives Identify the mechanisms of injury, classification schemes for ankle fractures. Identify the management principles of open reduction internal...

Ankle Fractures I Allen J Kempf, DPM, MS, FACFAS, DABPM Assistant Professor College of Podiatric Medicine and Surgery Des Moines University Objectives Identify the mechanisms of injury, classification schemes for ankle fractures. Identify the management principles of open reduction internal fixation of ankle fractures. Identify the specific concepts and details of ankle fracture fixation devices. Identify the criteria used to evaluate ankle fracture internal fixation devices. Anatomy- Osseous Structures Ankle joint made up of 3 osseous structures: Tibia Fibula Talus Functions as hinge or ginglymus type of synovial joint Complex joint which allows for triplane motion https://www.lecturio.com/concepts/ankle-joint/ Anatomy Ligamentous Structures Medial Ligaments: Superficial Deltoid Posterior tibiotalar ligament Tibionavicular ligament Tibiocalcaneal ligament Deep Deltoid Anterior tibiotalar ligament Lateral Ligaments: Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament h ttp s :/ / l i n k.s p r i n g e r.c o m / a r ti c l e / 1 0.1 0 0 7 / s 1 2 1 7 8 - 0 2 0 - 0 9 6 3 1 - 1 Anatomy- Syndesmotic Ligaments 4 main components: Anterior inferior tibiofibular ligament (AITFL) Posterior inferior tibiofibular ligament (PITFL) https://www.researchgate.net/figure/Graphic-anatomical-image-of-the-three-syndesmotic-ankle-ligaments-AITFL-anterior_fig1_335526109 Inferior transverse tibiofibular ligament Interosseous ligament Ankle Fracture Classification Systems Classification Systems Overview: Lauge-Hansen: Classification based on foot position and direction of deforming forces Danis-Weber: Classification based on radiographic appearance of fibular fracture in relation to the syndesmosis Lauge-Hansen Classification First word is describing the foot position (supination or pronation) Second word is describing the direction of the talar motion (adduction, abduction, eversion) 4 main groups based on the above: Supination-Adduction Pronation-Abduction Supination-External Rotation Pronation-External Rotation Always goes in order i.e. stage 1, stage 2, stage 3, etc. Lauge-Hansen: Supination-Adduction Stage 1: Transverse avulsion type fracture of distal fibula, below joint level or lateral collateral ligament tear Stage 2: Vertical medial malleolar fracture Supination-Adduction Stage 1 https://sites.uw.edu/eradsite/trauma-radiology-reference-resource/11-lower-extremity/lauge-hansen-classification-of-ankle-fractures/ https://www.podiatryinstitute.com/pdfs/Update_2009/2009_47.pdf Supination-Adduction Stage 2 h ttp s :/ / s i te s.u w.e d u / e r a d s i te / tr a u m a - r a d i o l o g y - r e f e r e n c e - r e s o u r c e / 1 1 - l o w e r - e x tr e m i ty / l a u g e - h a n s e n - c l a s s i f i c a ti o n - o f - a n k l e - f r a c tu r e s / https://www.podiatryinstitute.com/pdfs/Update_2009/2009_47.pdf Lauge-Hansen: Pronation-Abduction Stage 1: Transverse fracture of medial malleolus or deltoid ligament tear Stage 2: Posterior malleolar fracture or avulsion of AITFL/PITFL ligaments Stage 3: Short, oblique fibular fracture appearing transverse on lateral Pronation-Abduction Stage 1 Pronation-Abduction Stage 2 Pronation-Abduction Stage 3 Lauge-Hansen: Supination External Rotation Stage 1: Anterior inferior tibiofibular ligament injury/avulsion of insertion Stage 2: Spiral fracture of fibula with posterior spike on lateral imaging Stage 3: Posterior inferior tibiotalar ligament injury or posterior malleolar fracture Stage 4: Transverse fracture of medial malleolus or deltoid ligament injury Supination External Rotation Stage 1 Supination External Rotation Stage 2 Supination External Rotation Stage 3 Supination External Rotation Stage 4 Lauge-Hansen: Pronation External Rotation Stage 1: Transverse medial malleolar fracture or deltoid ligament injury Stage 2: Anterior inferior tibiofibular ligament rupture Stage 3: Oblique or spiral fracture of fibula above syndesmosis Stage 4: Posterior inferior tibiofibular ligament injury or posterior malleolar avulsion Pronation External Rotation Stage 1 Pronation External Rotation Stage 2 Pronation External Rotation Stage 3 Pronation External Rotation Stage 4 Danis-Weber Classification Classification based on radiographic appearance of fibular fracture in relation to the syndesmosis/ankle joint 3 main types: Type A Type B Type C Danis-Weber Classification Type A: Fracture of the lateral malleolus distal to the syndesmosis Type B: Fracture of the lateral malleolus at the level of the syndesmosis Type C: Fracture of the lateral malleolus above the syndesmosis Danis Weber Type A Danis Weber Type B Danis Weber Type C Danis-Weber and Lauge-Hansen Danis weber classification and Lauge-Hansen classification have overlap Danis-Weber A is an SAD stage 1 Danis-Weber B is an SER stage 2 or PAB stage 3 Danis-Weber C is a PER stage 3 Named Ankle Fractures Tillaux-Chaput: AITFL avulsion fracture from anterolateral tibia Wagstaff: AITFL avulsion fracture of anteromedial fibula Volkmann: PITFL avulsion fracture from posterior lateral tibia Bosworth: PITFL avulsion fracture from posterior medial fibula Maisonneuve: Proximal fibular fracture near fibular neck Sources Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries. Radiographics. 2012 Mar-Apr;32(2):E71-84. doi: 10.1148/rg.322115017. PMID: 22411951. Shiwaku K, Teramoto A, Iba K, Otsubo H, Kamiya T, Shoji H, Watanabe K, Yamashita T. The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: a retrospective study. BMC Musculoskelet Disord. 2022 Mar 18;23(1):264. doi: 10.1186/s12891-022-05220-0. PMID: 35303842; PMCID: PMC8932331. McGlamry ED, Southerland JT. Mcglamry's Comprehensive Textbook of Foot and Ankle Surgery. 4Th ed. / ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013. Modified from Dr. Smith Lecture Ankle Fractures 2021