A bone fracture is usually treated with a cast andor splint. Ankle fracture postop rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. The general goals of fracture management are anatomic reduction of the fracture and protection of the soft tissue envelope. The most effective methods for assessing tibiotalar instability include stress and weightbearing radiographs. In 915 patients, the posterior malleolus was a part of combined injuries i. This study aims to assess the functional outcome and result of.
Medication may also be prescribed to ease the pain of the fracture. Posterior malleolar fractures are a common component of ankle fractures. Both closed and open management of ankle fractures in diabetics have higher complication rates solution. Malleolus fracture through posterolateral for the management of posterior malleolus fractures, more studies are still required, though it is already wellrecognized for medial and lateral structure. Common management of ankle sprains acute care joint rest, ice, compression, and. It is typically treated by surgery and always needs. If a fracture is diagnosed by imaging or gross deformity. Ankle fractures symptoms, diagnosis and treatment bmj.
Although treatment of associated lateral and medial structures is well established, several controversies exist in the management of posterior malleolus fractures. Complicatonscomplicatons slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Lateral malleolar fracture an overview sciencedirect topics. The fibular fracture is classically fixed with a lag screw and an antiglide plate fig. May 27, 2017 general principles and methodsgeneral principles and methods of management of fractures. Epidemiology and treatment results for ankle fractures at. To reveal the recurrent patterns and characteristics of posterior malleolar fractures by creating fracture maps of the posterior malleolar fractures through the use of computed tomography.
Pdf trimalleolar fractures are one of the most complex fracture around ankle. Management of isolated lateral malleolar fracture new page 2. In most of the studies, the diagnosis and size of the posterior malleolus fracture was made from the lateral radiograph of the ankle. State the indication to fix posterior malleolar fractures.
Surgical management of bimalleolar fractures of ankle 472 p j m h s vol. So do we change the indications and goals of treatment. Lateral malleolus fracture healing time, treatment, icd. A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. Ankle fractures lecture orthopaedic trauma association.
Medial malleolar fractures were fixed with malleolar. Lateral malleolus fractures trigger pain, swelling, and bruising around the ankle. Medial malleolus fractures tibia only are relatively uncommon. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities a trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect. It is the fracture of the tibia shinbone on the posterior side in which chances of lateral malleolus fracture are very high as well due to the common ligaments shared between them. List the 3 common posterior malleolar fracture patterns. Surgical management of bimalleolar fractures of ankle zakir ali shah, uzma arif abstract. Lateral malleolus fractures cause pain, swelling, and bruising around the ankle. Pdf modified classification of posterior malleolus fracture. Oct 26, 2017 although a medial malleolus fracture can be a serious injury, the outlook for recovery is good, and complications are rare.
Uni malleolar fractures are the most common 68%, followed by bi malleolar fractures 25% and tri malleolar fractures 7%. Conservative management could result in fewer complications, reduced surgical time and lower cost. Sep 12, 2019 there are limited data reporting the outcome of patients with nonoperatively managed medial malleolus fractures compared to those treated surgically in the presence of fibular stabilisation for unstable fractures of the ankle. If there is a lot of soft tissue swelling over the lateral malleolus, but no fracture, then there has been a ligamentous injury. Management of ankle fractures rhode island medical society. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. This type of fracture is typically seen with patients who have had rotational forces acted on the leg or after landing from a forceful and impactful jump. In treating a fracture, the objectives of the treatment are as follows. Nevertheless, appropriate diagnosis and management of these injuries are not clearly understood. Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Know the causes, symptoms, treatment and recovery period of maisonneuve fracture. Non operative management of common fractures author. Operative treatment of posterior malleolar fractures. Lateral malleolus avulsion fracture this information will guide you through the next 6 weeks of your rehabilitation.
Specific changes in the program will be made by the. Surgical management of bimalleolar fractures of ankle. Displaced fractures are commonly treated with an open reduction and internal fixation. Bimalleolar fracture is a fracture of both the medial malleolus and the lateral malleolus. Long answer the ankle joint is the most commonly injured joint in sports and ankle fractures, accounting for 12% of acute orthopaedic admissions. Bone fractures management and treatment cleveland clinic. Fractures typesfractures types transversetransverse segmental segmental spiral spiral, green stick, green stick fracturefracture 3. Malleolus fracture an overview sciencedirect topics. Non operative management of common fractures mr duy thai orthopaedic surgeon mbbs, fracs ortho, dip surg anat avhap educational talk 28 june 2011, duy thai. When a broken ankle occurs, the injury may be to the end of the tibia the medial malleolus or to the fibula the lateral malleolus, or both 1. Management of the posterior malleolus in trimalleolar.
May 23, 2014 fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. Nov 28, 2019 pain and swelling on the inner side of the ankle along with a lateral malleolus fracture may indicate the possibility of an injury called bimalleolar equivalent fracture a specific type of unstable ankle fracture that may require surgery. May 08, 2017 a medial malleolus fracture is a crack or break in the medial malleolus plural form. Understanding what to do about a broken ankle requires some information about. Medial malleolus fracture symptoms, treatment, causes. A retrospective cohort study of 1 patients treated for an isolated ankle fracture with involvement of the posterior malleolus was performed. Jbjs 2006 but other fracture patterns have also been defined. Medial malleolar fractures non operative treatment make sure you have a full length fibula xray below knee plaster and crutches re xray at 12 weeks to ensure no displacement plaster off at 6 weeks. Pdf ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the. Remember that avulsion injuries may be small, and just involve the tip, or the internal surface of the.
A substantial part of all ankle fractures 744% involve the posterior malleolus 3. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or. Introduction ankle fractures are one of the most common lower limb fractures 1. Kreibich from sunderland district general hospital, england we compared two conservative methods of treating weber b1 laugehansen supinationeversion 2 isolated fractures of the lateral malleolus in 65 patients. Mostly the change of management plan occurred in ao type c followed by ao types b and a in descending order. Clinical examination findings are important but less reliable. A secondary type of posterior malleolar fracture is the posterior pilon variant. Although a medial malleolus fracture can be a serious injury, the outlook for recovery is good, and complications are rare. Anyone with a lateral malleolus fracture should be examined for signs of a more serious, unstable. Aug 14, 2019 as stated, whenever a medial malleolus fracture is seen, there are concerns about other damage to the bone and ligaments that may cause a more complex ankle injury. Traction may also be used to stabilize and realign fractures before surgery. Lateral malleolar fracture an overview sciencedirect.
Mar 14, 2017 the incidence of the posterior malleolar fracture pmf was reported to be 7 to 44% of all ankle fractures. Foot fractures frequently misdiagnosed as ankle sprains. Pain in other areas of the foot and ankle should be a reason to suspect a more serious ankle injury than an isolated lateral malleolus fracture. Numerous techniques and types of surgical access are reported in literature, but there is currently no consensus among the orthopaedics on the correct management of this fracture. Since coopers description of the trimalleolar fracture in 1822, several publications have discussed and analyzed the challenges and pitfalls of posterior malleolar fractures 47. Manual stress requires time and more radiation exposure. Despite of the evidence provided by anatomical and biomechanical studies that the posterior malleolus serves as an important contributor to the stability of ankle mortise and syndesmosis, the indication of surgical reduction and fixation of pmf remains controversial 24. All the patients had undergone lateral malleolus hook plate fixation surgery. In some cases when the bone is small toes or fingers, no cast is needed and the fracture is immobilized by wrapping. When an ankle fracture has been diagnosed, the choice of treatment. If the talus shifts during injury, it can strike the opposite malleolus and can cause an oblique fracture, often on the side of the bone that was subjected to the compression force.
The fracture pattern will help with the identification of the mechanism that caused the injury, and it will also increase the suspicion for a possible deltoid ligament injury. Ct articular involvement joint involvement posterior malleolar fracture pattern preoperative planning evaluate hindfoot and midfoot if needed mri ligament and tendon injury talar dome lesions syndesmosis injuries. Apr 06, 2018 maisonneuve fracture is a severe ankle injury which arises due to a spiral fracture of the proximal third of the fibula along with a tear of the distal tibiofibular syndesmosis and interosseous membrane. Fractures can occur at different levels of the medial malleolus. Maisonneuve fracturecausessymptomstreatmentrecovery period. Lateral malleolus fracture healing time, treatment, icd 9. The ap and lateral views from an ankle xray will almost always allow detection of a lateral malleolar fracture. Lateral malleolus avulsion fracture virtual fracture clinic. Lateral malleolus fracture healing time, treatment, icd 9, surgery, causes, diagnosis. Comparison of the direct and indirect reduction techniques. Posterior malleolus fractures are quite common and usually result from rotational ankle injuries.
Fracture type radiographic evaluation acute treatment definitive treatment follow. Ankle fractures are common and the majority are the result of low energy torsional trauma. This usually occurs in association with a traumatic force such as a rolled ankle or a direct blow and causes a sudden onset of intense pain in the area. Lateral malleolus hookplate fixation in the treatment of. Isolated lateral malleolus fractures represent one of the most common injuries encountered by orthopaedic surgeons. Management is determined by the location of the fracture. Medial malleolus fracture and broken ankle treatment. Can be associated with a disruption of the tibiofibular syndesmosis. Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. Traction uses a system of pulleys and weights to stretch the muscles and tendons around the broken bone. Single malleolar fracture is a lateral or medial malleolar fracture.
Pdf management of trimalleolar fracture in sanglah hospital. Stable fractures, where the alignment of the ankle. There are limited data reporting the outcome of patients with nonoperatively managed medial malleolus fractures compared to those treated surgically in the presence of fibular stabilisation for unstable fractures of the ankle. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities. The purpose of this study is to determine if any difference exists in. Pdf posterior malleolar fractures semantic scholar. Doctors will often treat this type of fracture with surgery. Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation 2 5. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. Commonly a lowenergy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus.
A lateral malleolus fracture is an injury involving a complete break in the boney prominence located at the outer aspect of the ankle i. Treatment strategy is the same as performed in lateral malleolus fractures. A cast or splint will immobilize the bone keep it from moving in order to encourage the bones to align straighten and to prevent use of the bone. Management of isolated lateral malleolus fractures. Inversion injuries are associated with a vertical fracture of the medial malleolus and a transverse fracture of the lateral malleolus. Most malleolar fractures are transverse fractures or small avulsion fractures just below the joint line. Pain in other locations of the foot and ankle need to be need to suspect a more severe ankle injury than an isolated lateral malleolus fracture. The lateral malleolus may be fixed by elevating the peroneal tendons laterally or medially through the same skin incision. Posterior malleolar fractures of the ankle article pdf available in european journal of trauma and emergency surgery 416 august 2015 with 5,228 reads how we measure reads. Malleolar fractures include injuries of bones malleoli and or ligaments. We report our results of posterior malleolar fracture management based on the classification by mason and molloy.
Any patient with a medial malleolus fracture should be carefully examined to ensure there is no other fracture or ligament damage surrounding the joint. Bimalleolar ankle fractures both tibia and fibula occur when there is an injury to both the inner and the outer side of the ankle. Ankle stability is maintained by ligamentous and bony anatomy. The aim of treatment is to restore and maintain stability and alignment of. There is increasing acceptance that the clinical outcomes following posterior malleolar fractures are less than satisfactory.
This type of fracture often arises from rotational injury and rarely occurs in isolation. Mar 27, 2019 numerous techniques and types of surgical access are reported in literature, but there is currently no consensus among the orthopaedics on the correct management of this fracture. The purpose of this study is to determine if any difference exists. Trimalleolar fracture is a specific injury in the ankle, where three areas known as the malleoli break simultaneously. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Trimalleolar fracture is a fracture of the lateral malleolus, medial malleolus, and posterior aspect of the distal tibial articular surface.
Fracture orientation not purely in coronal plane nearly always associated with the pull of the posterior tibfib ligament larger laterally than medially obliquely oriented involves the incisura haraguchi et al. A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. The deep deltoid ligament is considered the primary stabilizer of the ankle. Effect of ct on management plan in malleolar ankle fractures. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or with an injury to the ankle ligaments.