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Ankle fracture surgery is not needed if the ankle is in proper alignment and stable despite the fracture. This can typically be treated with a cast or walking boot. Just as the range of causes varies widely, so do treatments. When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. Weber B fractures occur at the level of the tibiofibular ligaments, just above the talar dome, and happen primarily through a mechanism of ankle supination and external rotation (SER).3 These type B fractures are sometimes stable, and patients can ambulate on them . Oblique (mortise) Best for evaluating for unstable fracture or soft tissue injury. Unstable bi and tri-malleolar ankle fractures require operative fixation with the goal to obtain and maintain a stable ankle mortise [ 1, 2, 3, 4, 5, 6, 7, 8, 9 ]. Open (compound) fractures are severe fractures in which the broken bones cut through the skin. Non-weight bearing or limited weight-bearing will limit pain, and allow the fracture to heal without being subject to excessive motion. It is very important to realize that a normal lateral or medial clear space does not exclude ligamentous rupture. At a point 1 cm proximal to tibial plafond space between tib/fib should be 6mm. However, for grossly displaced fractures it is often beneficial for the ankle joint to be repositioned (reduced) before the x-rays are taken. But if you go on increasing the length of the crack, a particular length will come when it will just go on propagating on its own. A splint is preferred to a cast as a splint allows for swelling where a cast does not. Do the following every waking hour 10-15 times. sustaining isolated ankle sprains. Unstable pelvic fractures are most often caused by high-impact events such as a . However, if the bone has moved out of place and can be put back in to position - a procedure called closed reduction nonsurgical treatment may be sufficient. with the foot on a pillow when you are lying down). An unstable fracture is a more serious injury involving bones and ligaments (which may tear or even pull off a small chip of bone where they attach). On the right image there is an unstable fracture. Stable vs Unstable : Stable vs Unstable The ankle is a ring Tibial plafond Medial malleolus Deltoid ligaments calcaneous Lateral collateral ligaments Lateral malleolus Syndesmosis Fracture of single part usually stable Fracture > 1 part = unstable Source: Rosen . . Most commonly, unstable fractures of the ankle require surgery to restore the anatomy and stabilize the injury. FootEducation LLC Pursued for patients at very high-risk of perioperative mortality or non-ambulatory at baseline. Close contact casting was delivered successfully for most participants, substantially reducing . The ring is broken in only one place. An unstable ankle fracture can occur when an injury compromises the integrity or stability of the ankle joint. Pain may include general pain and discomfort, swelling, aching, redness, bruising, burning or stabbing sensations, and/or loss of sensation. 5 However, because of various comorbidities . Grade III injuries are unstable and generally require surgical stabilization via a screw, tightrope fixation, or suture button fixation. It simply means that there is no dislocation, but there can still be instability. In some fractures there may even be a proximal fibular fracture - which is not visible on the ankle radiographs - in combination with ligamentous ruptures at the level of the ankle. Further diagnosis may include sensation tests, a physical examination, and potentially x-rays or other imaging tests. The x-ray beam has to be centered on the malleoli. It is important to think of the focus of the initial phase of treatment as the control of swelling. The main objective of this systematic review was to examine the available literature and identify the variables that affect the management of posterior malleolar fractures and how these are related to the outcomes. Weakness in great toe extension. On the left image a Weber A or SA-fracture. A positive squeeze test and injury to the ATFL and deltoid ligament are important factors in differentiating stable from dynamically unstable grade II injuries and may be used to identify which athletes may benefit from early arthroscopic assessment and stabilization. If, in addition to being open there is gross instability an external fixator may be applied. The syndesmosis is the fibrous connection between the fibula and tibia formed by the anterior and posterior tibiofibular ligaments - located at the level of the tibial plafond (French for ceiling) - and the interosseus ligament, which is the thickened lower portion of the interosseus membrane. Some more common treatments are rest, ice packs, keeping pressure off the foot, orthotics and braces, medication for inflammation and pain, and surgery. However, although the outside bone is fractured, the ankle joint itself remains well positioned and stable. On a true AP-view the talus overlaps a portion of the lateral malleolus, obscuring the lateral aspect of the ankle joint. It is common for it to take six months (or more) for patients to feel comfortable performing basic everyday activities (walking a number of blocks, standing for prolonged periods, basic sporting activities, etc.) If the ankle is dislocated it will be necessary for a physician to realign or reduce the deformity. In general, there are many different classification systems used for fractures which fall within a set number of patterns: Complete: Extends all the way across the bone (most common) Incomplete: does not cross the bone completely (usually encountered in children) Non-Displaced / Stable: Fractured ends of the bone line up Displaced / Unstable: Fractured portions of bone are separated or misaligned. Upon arrival to the emergency department, the injury is again assessed. TY - JOUR T1 - Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures. The ring was broken in two places and after repairing one of them, the ring was stable. Therefore the ankle joint itself remains anatomically positioned and stable. On the right image there is an unstable fracture. stable fractures treated nonsurgically. These injuries may also occur while participating in sports and recreational activities. On the posterior side frequently the posterior malleolus avulses. Immobilizing the leg, ankle and foot can provide comfort and prevent further injury. San Francisco CA 94123, Did you know our resouces can be found in. About 40% of patients with hip fractures require blood transfusions (Desai 2014) Patients with intertrochanteric fractures are twice as likely to need blood transfusion as those with a femoral neck fracture. The medial side of the joint is quite rigid because the medial malleolus - unlike the lateral malleolus - is attached to the tibia and the medial collateral ligaments are very strong. Ankle pain can have many different causes and the pain may potentially be serious. There may also be discoloration of the foot if blood flow is interrupted. A Aggressive rehabilitation working on regaining lost strength, motion, and, Did you know our resouces can be found in. Pain may include general pain and discomfort, swelling, aching, redness, bruising, burning or stabbing sensations, and/or loss of sensation. The fracture may involve the ligaments that hold the joint together, the joint surfaces themselves or a combination of both. If safe transport is unavailable, emergency medical services should be contacted. In a stable fracture, the ankle is still positioned correctly and stable, despite a fracture in the bone. We can assume that this is a Lauge Hansen Supination Adduction injury stage 2. Open Reduction with Internal Fixation. Now anyone can figure out, that an ankle is unstable when both the medial and the lateral malleoli are fractured. The treatment of unstable fractures includes management of the bleeding and injuries of the internal organs, blood vessels, and nerves. Ankle pain is any condition that causes pain in the ankle. Unstable fractures are those in which fragments of the broken bone are misaligned and displaced. An unstable fracture is one that is likely to change further, possibly damaging nerves and other tissue in the process or creating an unacceptable spinal deformity. Intervention: After lateral malleolar fixation, syndesmotic stability was evaluated by an external rotation stress examination under direct vision and fluoroscopy. To that end, a systematic review was performed based on . Certain fracture patterns are stable and are thus treated without surgery similarly to ankle sprains. In unstable ankle fractures, the ankle joint itself is displaced or can be displaced when it is subject to normal forces. Stable vs Unstable ankle fractures Stable fracture: although a bone is broken, the ankle joint itself remains well positioned and stable - theses are normally managed with a walking cast or boot. The case on the left shows a Weber B fracture. Stable fractures treated without surgery can often be safe for immediate protected (in a boot) weight bearing. Types of fractures include: Simple fractures in which the fractured pieces of bone are well aligned and stable. If the deltoid ligament is torn in association with a fracture, the ankle is generally unstable. We are OPEN and requiring masks be worn for all in-office visits. (physics) Radioactive, especially with a short half-life. The lateral clear space is measured from the medial border of the fibula to the lateral border of the posterior tibia 1cm above the tibial plafond. Malpositioning of the lateral view is the most common mistake in radiography of the injured ankle. An oblique or vertically oriented fracture indicates 'push-off'. Evident widening of the lateral clear space indicates syndesmotic rupture. The anterior and posterior tibiofibular ligaments are often referred to as anterior and posterior syndesmosis. Ankle fracture refers to fracture of the bones which make up the ankle (talus, tibia, fibula) Dislocation refers to loss of congruence of the joint usually associated with fractures. We recommend wearing the Ossur Exoform Ankle Brace. If you have ankle pain, consult with Dr. Thong V. Truongfrom California. 11% (218/1990) 3. In 20% of fractures the foot is in pronation with maximum tension on the medial side. This was the only fracture that was seen on the x-rays of the ankle and this patient turned out to have an unstable Weber-C fracture and went for surgery. Most ankle fractures with dislocations require surgical treatment. The evaluation and treatment of the posterior malleolus fracture in unstable ankle injuries remain a topic of controversy. Swelling with a cast in place may cause problems with circulation. Weakness in ankle plantarflexion. Ankle fractures are a common type of injury. Ankle - Fractures 1 Weber and Lauge-Hansen classification. Fickle. Weber classified them as: type A - infrasyndesmotic type B - transsyndesmotic type C - suprasyndesmotic These fractures are identical to the fractures described by Lauge-Hansen as supination-adduction, supination-exorotation and pronation-exorotation. Notice that at first the foot is in supination with maximal forces on the lateral side. Over a 7-year period, 238 skeletally mature patients with unstable SE pattern Weber B lateral malleolus fractures with deltoid ligament incompetence were evaluated. Reducing a dislocated ankle fracture is performed using some combination of sedation, pain medication, muscle relaxers, and local anesthetics depending on the emergency room physicians assessment of the patient. Etiology. Reduction of a dislocated ankle joint is an urgent priority and usually performed in the emergency department. They are associated with pain, resulting in it being very difficult or even impossible to walk on the ankle. The injury starts on the lateral side, since that is where the maximum tension is. After the injury the bones frequently align again. Having a strong tendency to change. Loss of normal anatomical relationships at rest or under physiologic loading 4/19/2016 17 Decision Making Stable Conservative Tx 4/19/2016 18 Medial Malleolar Fractures . The most common causes of ankle pain include: Symptoms of ankle injury vary based upon the condition. Twisting Fractures of the Fibula (Weber B1-type fractures). There is a Weber B fracture. This can typically be treated with a cast or walking boot. Relative immobilization. 269 Chestnut St. #271 Stable vs Unstable The ankle is a ring Tibial plafond Medial malleolus Deltoid ligaments calcaneous Lateral collateral ligaments Lateral malleolus Syndesmosis Source: Rosen Stable vs Unstable Fracture 1 part = usually stable Fracture > 1 part = unstable Unstable fractures Lateral talar shift Bimalleolar Lateral fractures + medial tenderness A previous ankle fracture may increase the risk of ankle arthritis. There was no indication for a syndesmotic screw. Request an appointment 617-724-9338 About our center Pulling Fractures of the Fibula (Avulsion or Weber A type fractures). This indicates that there is a syndesmotic rupture and medial collateral ligament rupture. Due to the wide variety of potential causes of ankle pain, podiatrists will utilize a number of different methods to properly diagnose ankle pain. The ankle joint is unstable and dislocated. It is less well defined because its width varies with positioning. A stable versus an unstable fracture is another way a provider will classify your spinal fracture. Less commonly the anterior syndesmosis avulses from the tibial attachment - Tillaux fracture.C This will encourage the ankle to move in all directions. This can include asking for personal and family medical histories and of any recent injuries. An unstable fracture is a more serious injury involving bones and ligaments (which may tear or even pull off a small chip of bone where they attach). The size and location of the wound will determine the next step. Stability (4) The ankle can be thought of as a ring in which bones as well as ligaments play an equally important role in the maintenance of joint stability. Early Range of Motion. Stable vs unstable spine fractures. However, it often takes many months for the fracture, soft-tissues, and muscle strength to return to pre-injury levels. Rehabilitation. The ring of the ankle is broken in two places. Open fracture. Once crutches are no longer needed, more aggressive therapy begins in the rehabilitation phase. A displaced ankle fracture is where the broken bone fragments are separated. When excessive force causes one or more of these bones to crack, this is known as an ankle fracture. or is badly contaminated, meaning dirt or other material from the environment ended up in the wound a second look at the wound and wash out may be necessary before fixation is finalized. These injuries can result from any number of traumatic causes from a twisting injury to a car accident. Almost every ligamentous rupture has a fracture equivalent. The result is an SA or Weber A fracture. Stability (3) Stability (5) Arrangements can be made for a knee scooter, walker or wheelchair if necessary. In 80% of ankle fractures the foot is in supination. If the joint is displaced or if there is some question about the integrity of the ankle joint, then surgery is often indicated. Though you may still experience significant pain with a stable fracture, it does not put you at immediate risk and tends to heal with fewer complications. The goal of rigid internal fixation is to stabilize the fracture allowing early motion of the involved joint(s). Ankle fractures can be broadly divided into stable or unstable injuries. Copyright George Yarnell, DPM | Site Map | Nondiscrimination Policy | Design by: Podiatry Content Connection, We are OPEN and following all CDC Guidelines. Usage. On a well positioned lateral view the tertius fracture is obvious (red arrow). Not stable; not standing fast or firm; unstable; prone to change or recede from a purpose; mutable; inconstant. This can typically be treated with a cast or walking boot. If you have any questions, please feel free to contact our offices located in Chico, and Oroville, CA . Immediate medical attention is necessary to assess the extent of the injuries including any associated skin wounds, the extent of any deformity, and the impairment of sensation and circulation. Manoli, A, Egol, K. Outcomes over a decade after surgery for unstable ankle fracture: functional recovery seen 1 year postoperatively does not decay with time. stable vs unstable fracture. Treatment is non-operative, although it often takes 6 weeks or more for the bone to heal. The ankle joint consists of three bones: the fibula and tibia in the lower leg and the talus in the foot. Ankle Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports Because the patient is in pain, the technologist is afraid to let the patient turn the ankle fully lateral. Treatment is typically operative fixation depending on degree of pelvis instability, fracture displacement and patient activity demands. An attempt to weight-bear should be avoided if at all possible. Ankle fractures represent 10% of all fractures. This may be a cast, a splint, or removable boot. These injuries are equivalent to a severe. Then, you can gradually progress to putting weight on the ankle again. This view visualizes both the lateral and medial joint spaces. - if ankle is stable, very little displacement will occur at lateral complex with stress abduction and eversion; - if little or no displacement is present in the fibula, and there is no evidence of a posterior or medial injury, nonoperative treatment is indicated; This can typically be treated with a cast or walking boot. Initial management of the fracture begins at the scene of the injury. 4/19/2016 14 Initial Treatment Need to reduce dislocations! The main potential complication that is specific to an unstable ankle fracture is the potential for traumaticankle arthritis. On the left image a Weber A or SA-fracture. A transverse or horizontal fracture is the result of a 'pull-off'. In general, the ankle should be elevated 6-12 inches above the heart (i.e. The ring of the ankle is broken in two places. Commonly, a walking boot such as a. The forces in ankle injuries can be enormous. There are two positions of the foot in which the flexible ankle joint becomes a rigid and vulnerable system: extreme supination and pronation. These rules are used to determine the need for radiographs in patients with an ankle injury. This type of injury may occur by stepping awkwardly and twisting when walking down steps or stepping off of a curb. Pelvic fractures that happen from low-impact events, such as a minor fall or running, are usually stable fractures. Stable ankle fractures involve a fracture of the outside bone of the ankle joint (the fibula). On the lateral side there is a flexible support by the fibula, syndesmosis and lateral collateral ligaments. The mechanism of injury varies, although it often involves some type of twisting injury to the ankle. If the talus does not move properly or is incapable of moving at all, then the fracture is considered unstable and requires more invasive methods of treatment. We found lateral malleolar fractures could be treated nonoperatively with success if the ankle mortise was stable. stable pelvic fractures are able to tolerate normal physiologic loading without significant displacement, often heal without intervention, and are not typically considered life-threatening injuries 1 Definitions hemodynamically unstable - defined by Advanced Trauma Life Support (ATLS) as all of the following In addition, the orthopedic surgeon may recommend further imaging if not already performed at the time of the emergency room visit. In an unstable ankle fracture, the joint will not support weight-bearing without displacing. In either case, patients will describe pain and swelling in their ankle. There are two parts involved in the treatment of a stable lateral malleolus fracture. 4 Excellent results are predicted with open reduction and internal fixation of unstable ankle fractures. The talus is displaced laterally. Ice is used to decrease the blood flow to the ankle and therefore decrease the swelling. On the left another case. The pins are placed through small incisions, they protrude from the skin and are spanned by a bar. Basically there are three main types of ankle fractures. However, the ankle joint itself will be intactand will beexactly where it should be. Elevation. Operating before swelling resolves sufficiently can increase the risk of wound problems leading to infection. In a stable fracture, the ankle is still positioned correctly and stable, despite a fracture in the bone. Call for more information on telehealth appointments as well! Unstable ankle fractures tend to swell quite a bit. As a rule, this type of injury requires immediate care and medical attention. There are many combinations of avulsion fractures and ligamentous ruptures that can produce an unstable ring in the axial plane. When the anterior and posterior syndesmosis rupture or avulse, then the ankle mortise is unstable. This can typically be treated with a cast or walking boot. Elevation will help limit the swelling and thereby decrease the pain. The foot may be rolled to the inside similar to an ankle sprain, or the foot may be fixed on the ground while the body rotates around it. Ankle Fractures. Start the video on the left by clicking on the image. If the fracture and/or dislocation is grossly unstable, an external fixator may need to be applied. This lateral complex allows the talus to move laterally and dorsally in exorotation during forward motion and subsequently pushes it back into its normal position. Modern ankle fracture treatment in the general population to obtain good functional healing and early mobilization is achieved with anatomic restoration of the ankle mortise and stable fixation. It is important to realize, that for the stability of the ankle it doesn't matter whether there is a rupture of a ligament or an avulsion at the insertion. Stable ankle fractures involve a fracture of the outside bone of the ankle joint (the fibula). Ankle fractures are a common type of injury. Patients/participants: Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demonstrating an increase in medial clear space to 5 mm or greater were followed for 12 months after treatment. On the lateral view and also on the AP- and Mortise views, which will be shown in the paragraph on tertius fractures, this fracture was not visible. External fixation consists of placing pins into the bone above and below the fracture of unstable joint. In some cases, the bones of the ankle may poke through the skin. The deltoid ligament is found on the inner part of the ankle and provides the majority of the stability of the ankle. These fractures can be stable or unstable. Notice that at first the foot is in pronation, with maximum forces on the medial side. When excessive force causes one or more of these bones to crack, this is known as an ankle fracture. Chance fractures also referred to as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. If the wound is a result of a high energy mechanism (car accident, fall from height, etc.) These injuries result in marked pain and almost immediate swelling of the ankle. Patients undergoing surgical management of an unstable ankle fracture usually require a minimum of 6 weeks non-weight-bearing in some form of immobilization. Definition. Both the medial and lateral clear spaces are widened, indicating instability. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture. If the deformity cannot be corrected by these means, the patient may require urgent surgery to reduce the joint or realign the limb. Non-operative. Both the medial and lateral clear spaces are prominent, but within normal limits. Citation, DOI & article data. Ice. The fracture may involve the ligaments that hold the joint together, the joint surfaces themselves or a combination of both. If you have ankle pain, consult with Dr. George Yarnellfrom Pennsylvania. Physical therapy focuses on restoring ankle motion, strength and balance, or the bodies protective reflexes referred to as proprioception. Dislocation is the dissociation or separation of the bones that make up the joint where they are no longer in contact as a result of the injury. The Mortise-view is an AP-view taken with a 15-25? normal walking) through the ankle joint. The immediate application of ice can also help with pain and slow swelling. AU - Mandel,Jessica, AU - Behery,Omar, AU - Narayanan,Rajkishen, AU - Konda,Sanjit R, AU - Egol,Kenneth A, Y1 - 2019/04/11/ PY - 2019/4/12/pubmed PY - 2020/2/25/medline PY - 2019/4/12/entrez KW - ankle fracture KW - medial malleolus KW - screw fixation SP - 790 EP - 796 JF - Foot & ankle . Fibular fractures above the lateral malleolus, tibial fractures, and ankle injuries other than fractures are discussed elsewhere. However, the key determinants influencing arthritis are cartilage damage occurring at the time of the original injury, the accuracy with which the joint surface was restored at surgery and the restoration of joint motion, muscle strength and proprioception during therapy. Continue with the images post surgery. Ankle X-ray series are only required in case of: Subsequently the foot exorotates. San Francisco CA 94123, Pulling Fractures of the Fibula (Avulsion or Weber A type fractures). Crutches are provided to help avoid weight bearing on the injured limb. Weber (1966). Sometimes these fractures are difficult to detect, as we will discuss in a moment.D . Ankle pain is any condition that causes pain in the ankle. They are associated with pain, resulting in it being very difficult or even impossible to walk on the ankle. It is important to realize that in these cases the radiographs of the ankle may be normal, while there still is an unstable ankle injury. Many think that for a good lateral view the distal fibula should be in the center of the distal tibia. Unpredictable. This type of wound often represents an open fracture as the fracture communicates with the outside world thereby increasing the chance of infection and demanding urgent treatment. The focus of surgical management of unstable ankle fractures is restoring the relationship of the joint surfaces, correcting alignment and stabilizing the fracture, usually with plates and screws, referred to as rigid internal fixation. If you have any questions, please feel free to contact our office located in Lansdowne, PA . Higher energy injuries such as falling from a height or being involved in a motor vehicle accidents are also common causes of unstable ankle fractures. A certain amount of blood flowing to the ankle is important, however, in patients who have recently suffered an ankle fracture, there is often too much blood flowing to the area. Thats called the critical crack length More answers below Rohit Rawat X-rays will be obtained to appreciate the bony detail of the injury. Take a knife and pierce the sheet a bit, if the sheet doesn't tear apart completely, its a stable crack, if it does its unstable. Fluctuating; not constant. Displacement of the distal fibula after treatment did not affect functional scores or pain. The medial clear space should not exceed 4 mm and is usually equal to the distance between the tibial plafond and the talus. During the procedure, your surgeon will restore the original alignment of the fractured bones and hold them in place with surgical hardware, typically: (chemistry) Readily decomposable. Another reason for urgent operative treatment is in the event that a fracture fragment has broken through the skin, referred to as an open fracture. Open fractures require urgent surgery to washout the wound and minimize the chance of infection. The AO Surgery Reference is a huge online repository of surgical knowledge, consisting of more than 7000 pages. Surgery is usually delayed until swelling resolves sufficiently to perform surgery safely. We can conclude that there is no dislocation, but we do not know if there is rupture of the medial collateral ligaments or of the syndesmosis. The shape of a fracture indicates which forces were involved. On the right image the medial malleolus is pulled off by the medial collateral ligament due to pronation of the foot. In older adults with unstable ankle fractures, a strategy of commencing fracture management with close contact casting resulted in ankle function equivalent to that with immediate surgery, with fewer wound complications and reduced intervention costs. However, although the outside bone is fractured,the ankle joint itself remains well positioned and stable. An unstable fracture is a more serious injury involving bones and ligaments (which may tear or even pull off a small chip of bone where they attach). In these fractures, the foot (and therefore the lower bone of the ankle) is fixed on the ground while the body (and therefore the two upper bones of the ankle) rotates inwards, causing the outer ankle bone (the fibula) to break (Figure 2). Unstable fractures require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs. Notice the exorotation of the foot for a proper lateral view. Unstable ankle fracture: the stability or structure of the ankle joint is affected by the break. 83% Types of arthritis (rheumatoid, osteoarthritis, and gout). If you need a more accessible version of this website, click this button on the right. These are unstable injuries and have a high association with intra-abdominal injuries. Due to the fact that the ankle consists of tendons, muscles, bones, and ligaments, ankle pain can come from a number of different conditions. . The x-ray beam is not parallel to the fracture line. The name of the surgical procedure for repairing ankle fracture with an unstable syndesmosis is called an open reduction with internal fixation. When the ankle is subluxed or dislocated in these injuries, the ankle is clearly unstable. External fixation is a means of rigidly stabilizing an unstable fracture and/or dislocation. Instable vs. Unstable. Fractures of the ankle are classified as stable or unstable, which has to do with the stability of the talus. The mean age at injury is 45 years, significantly older than that of patients. Stable ankle fractures involve a fracture of the outside bone of the ankle joint (the fibula). Anteriorly the anterior syndesmosis (or antior tibiofibular ligament) is one of the first structures to rupture. An unstable fracture is a more serious injury involving bones and ligaments (which may tear or even pull off a small chip of bone where they attach). Follow up with an orthopedic surgeon should be arranged in the near future. Any of the above fractures can also be classified as stable or unstable: A stable fracture is one that is unlikely to undergo further changes, creating further damage. Start the video on the left by clicking on the image. The condition of the skin, nerve function and circulation are evaluated. We offer the newest diagnostic and treatment technologies for all your foot care needs. The most common causes of ankle pain include: Symptoms of ankle injury vary based upon the condition. Follow up with an orthopedic surgeon should be scheduled for within 2 to 3 days of the injury to address timing of surgery and any specific patient needs. In contrast, if only the lateral malleolus is injured, the Weber B injury may be either stable or unstable. The area of the posterior malleolus (distal tibia, immediately behind the medial malleolus) should also be palpated for tenderness. When it is broken in two places, the ring is unstable and may dislocate. Patient was scheduled for osteosynthesis of the fibular fracture and placement of a syndesmotic screw if necessary. Some state that a width of 5.5 mm is abnormal. Sit in a chair. 269 Chestnut St. #271 Patients may also experience numbness or tingling in the case of nerve injury. These bones are bound by a ring of ligaments that support and stabilize the ankle joint. It can be a total of 12-18 months for complete recovery. It is important to identify any associated skin wounds, the extent of any deformity and any impairment of sensation and circulation. While the three-column concept was initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as the general vertebral anatomy is similar to the thoracic and lumbar vertebrae. A stable fracture means that the break-in of your bone does not compromise the spine's integrity. It is important for the patient to be evaluated sooner rather than later to determine if surgery is necessary and when it should be scheduled. In a stable fracture, the ankle is still positioned correctly and stable, despite a fracture in the bone. Our doctor will assess your condition and provide you with quality foot and ankle treatment. In this article we will focus on: The ankle joint has to be flexible in order to deal with the enormous forces applied exerted on the talus within the ankle fork. In a stable fracture, the ankle is still positioned correctly and stable, despite a fracture in the bone. The fibula has no weight-bearing function, but merely serves as a flexible lateral support. Ankle Fractures Phong Tran Orthopaedic Surgeon Western Health Surgical intervention may be employed for fixation of the fractured pelvic bones using screws and plates. If you have suffered an injury and your ankle is painful, swollen, or unable to sustain weight, make an appointment with a podiatrist as soon as possible to get properly diagnosed and treated. There is a lateral fracture and on the medial side there is a rupture of the collateral ligament allowing the talus to dislocate laterally. Stability (6) The total time to a complete recovery can be many months. This ankle is stable because there is only an avulsion fracture of the lateral malleolus below the level of the syndesmosis. Nonsurgical treatment may be an option when the break is minor, the bones are in alignment, and the ankle is stable. Widening of the medial joint space up to 6 mm or more requires disruption of the medial collateral ligament. In the case of a large wound that can be adequately washed out, the fracture may be stabilized with plates and screws at that time. Resurgery was necessary with placement of a syndesmotic screw to stabilize the ankle joint. This can include asking for personal and family medical histories and of any recent injuries. Weber C fractures are almost always unstable and require surgical intervention. This topic review will provide an overview of ankle fractures that result from minor trauma (ie, indirect or low energy fractures), including a basic approach to their evaluation and management. endorotation of the foot. However, unstable fractures requiring surgery usually need at least 8 weeks of non weight bearing to allow proper healing. Due to the wide variety of potential causes of ankle pain, podiatrists will utilize a number of different methods to properly diagnose ankle pain. Following x-rays, a decision point is reached. Depending on physical examination and x-ray findings at 6 to 8 weeks, progressive weight-bearing may begin. This more severe trauma to the ankle structure can compromise its stability and require more intensive treatment. D) Seated Calf Raise. Further diagnosis may include sensation tests, a physical examination, and potentially x-rays or other imaging tests. Ankle fractures directly or indirectly involve the ankle joint. Time. Early motion, usually after the incision(s) is/are healed (~2 weeks) can avoid the joint stiffness, muscle atrophy (shrinkage), nerve and skin changes that can result from long-term immobilization referred to as fracture disease. Avoiding or minimizing these changes can streamline the rehab process and restore normal function more efficiently. A well-padded splint is applied. This ankle is stable because there is only an avulsion fracture of the lateral malleolus below the level of the syndesmosis. A) Alternate the ankle between dorsiflexion and plantarflexion. Usually, it takes a minimum of 6 weeks before a bone, such as the fibula, to heal enough to withstand normal everyday forces (ex. This is best accomplished by avoiding weight-bearing and keeping the injured foot/ankle elevated above the level of the heart with the exception of getting up to eat or use the bathroom. The patient may be discharged home with pain medications and instructions for elevating and icing. After osteosynthesis of the fibula, the ankle was tested in the operating room and found to be stable. Copyright Dr. Thong Truong, DPM, INC. | Site Map | Nondiscrimination Policy | Design by: Podiatry Content Connection. The ankle is the most frequently injured joint. A deformity may just as likely occur in association with a motor vehicle as with a misstep off a curb. Due to the fact that the ankle consists of tendons, muscles, bones, and ligaments, ankle pain can come from a number of different conditions. Management decisions are based on the interpretation of the AP and lateral X-rays. When ligaments are torn and associated with an ankle fracture, this damage can render the ankle unstable. The ankle joint itself is stable so early motion can help prevent stiffness and allow muscle strength to be retained. Just as the range of causes varies widely, so do treatments. The technologist turns the foot inwards until the lateral malleolus is at the same height as the medial malleolus. Due to its simplicity, it is widely used in routine clinical practice and can be used in reports with the expectation that the treating . An unstable fracture is a more serious injury involving bones and ligaments (which may tear or even pull off a small chip of bone where they attach). It has been broadly accepted that Weber B and C injuries are likely unstable, requiring internal fixation. There are two common types of stable ankle fractures: Stable ankle fractures may be treated without surgery because the ankle joint itself remains truly stable. Once the ankle is aligned and stabilized, or in the absence of deformity or open injury, the patient is immobilized. 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