Ankle fx's

quickster2008's version from 2015-12-13 00:59


Question Answer
how would you know syndesmosis is rupturedgap btw fibiular & tibia
broden view highlightsposterior facet of STJ
xray presentation of ankle fxlateral view: shows if fibula migrated or post mall is migrated, mortise view-shows syndesmosis rupture, broden view-shows post facet rupture
lateral view helps u diagnose ankle fx byshowing if fibula migrated or post malleolus migrated
see syndesmosis rupture on what viewmortise
how would you know if there is osteoporosis of the bone1/3-1/4 bone cortex rule
MOA of ankle fxnormal forces thr abnormal bones(osteoporosis), abnormal forces thr normal bones(trauma)
danis weber A * KNOWinfra syndesmotic, isolated fix fx BELOW syndesmosis, ass w/M. instability
danis weber Btrans syndesmotic, ass w/posterior spike
danis weber Csupra syndesmotic, ass w/rupture of deep deltoid
most common type of danis weberB
ligament that stabilizes AJATFL
ligament that stabilizes STJCFL
SAD 1TRANSVERSE fx of L. mall below the level of the syndesmosis or rupture of lateral collateral ligaments
SAD 2SAD 1 and oblique fx of M mall
Danis weber A correlates with LH ?SAD 1
SER 1rupture of anterior inferior tibiofibular ligament(high ankle sprain)
SER 2SER 1 and OBLIQUE or SPIRAL fx of fibula at the level of the ankle jt producing posterior spike!! (TQ)
what type of fx runs from ant inferior to post superior producing a hallmark posterior spikedanis weber B or SER 2
tillaux chaputAITFL avulsion fx from the anterolateral tibia seen in SER 1 or PER 2
wagstaffeAITFL avulsion fx from the anteriomedial fibula, seen in SER 1 and PER 2
SER 3SER1,2, adn rupture of PITF or fx of the post mall(volkmann's fx)
SER 4SER1,2,3 and fx of M mall or rupture of deltoid lig
danis weber B correlates with LH ?SER and PAB
PER 1transverse fx M mall or deltoid rupture
PER 2Per 1 and rupture of anterior syndesmosis (AITFL)
PER 3PER 1,2, and oblique fib fx above the level of the syndesmosis(DW C)
PER 4PER 1,2,3, and avulsion of post mall(Volkmann's) or rupture of PITF
volkmann's fxposterior malleolar fx seen in PER 4
PAB 1Transverse M. mall fx
PAB 2PAB 1, An tib fib lit or Post tib fib lig rupture
PAB 3PAB1,2, and transverse or oblique fib fx at or above the syndesmosis, typically a BUTTERFLY FRAGMENT
danis weber C correlates with LH ?PER
vassel's principlereduction & stabilizaiton of primary fx shoulw allow lesser fx fragments to fall into proper anatomical alignment due to common ST elements surround fx(why fx fibula will automatically reduce tibia)
sign pt has osteoporosispain in the morning
should have no more than ? of clear space2mm
why do we fixate danis weber BBc of instability. Talus will always shift with fibula
what makes PAB 3 uniquebutterfly fragment
pt positioning to fixate ankle fxsupine, bump under ipsilateral hip, thigh TQ, C arm on side contralateral to fx,
stepwise techniquereduce fib fx before med mall(bc talus follows fib)
vassel's or vasulus principlealways want to reduce bone that is in the worst shape & rest of bones will follow
? is the key to anatomical reduction of bimalleolar fx's bc displacement of the talus faithfully follows this thus restoring stability of the anklelateral malleolus
what structure do you worry about anterior to m. malleolussaphenous nerve
what structures do you worry about posterior to m. mallflexor tendons, post tib nerve, post tib a
what do you close first fibula or m. mall?fibula bc talus follows fibula and talus causes instability
when should you fixate the post mallif fracture is > 25% of the surface area of the joint
cotton test?
screws used for fixation for syndesmosis ankle fxlag screw(cortical screw) + 1/3 tubular screw, can use non-locking screw to get plate in place where u want it, locking screw to screw into place where u want it
how do you fix a lag screw1/3 tubular plate
what does it mean if you get a hemorrhagic fx blister after fixing post mallmeans vascular compromise in the dermis is damaged and deep dermis is damaged.
fixation for syndesmosis ankle fx1cm above syndesmosis & 1cm below
how many screws do you need to fix syndesmosis injury*2 screws, 1 cm prox to jt, 4 cm prox to jt
the most predictable complication of ankle fx'spost operative/post traumatic arthritis
post op complications dehiscence, infection, non union, malunion, edema, post op arthritis
what denis weber fractures should you fixate with ORIFB and C


Question Answer
most common LH typeSER
what does the first & second part of the name LH meanfirst part is position of foot at time of injury, second part is deforming force or motion of talus through injury
lateral collateral ligamentsATFL, calcaneofibular ligament, posterior talofibular ligament
vascular compromise is often caused bymalalignment of ankle(immediate reduction is necessary)
ankle fx dislocations(TQ) maycompromise vascularity to the foot, lead to pressure ischemia of skin, incr articular injury to both talus & tibia
cotton's fxtrimalleolar fx
dupuytren fxalso called pott's fx bimalleolar fx
How would you anesthetize the ankle for close reductionhematoma block or conscious sedation
hematoma block5-15ml of lidocaine injected into ankle jt
conscious sedationcombo of benzodiazepines(midazolam) & narcotics (morphine, fentanyl)
how do you reduce a fractureexaggerate the injury mechanism, distract, reduce the fx
how would you maintain reduction after you have reduced a fxjones compression with posterior splint
non operative tx is reserved for pts withisolated non displaced fx(DW A) SER 2(unless deltoid ligament integrity is in question) or commorbidities that may contraindicate operation
4 commorbidities that may contraindicate surgeryPeripheral vascular dz, uncontrolled DM, neuropathy, immune compromise
complications associated with nonoperative txfailure to attain anatomic reduction, loss of reduction, disuse atrophy in cast, delay in onset of ROM exercises
what is better ORIF vs closed reduction & plaster castboth good
operative tx necessary if displacement of fx is > than ? mm2mm
operative tx necessary if lateral talar shift of ? mm or more2mm
operative tx necessary if fx of posterior malleolus involving > ? % of articular surface25-30%
T or F operative tx is always needed for open fx of ankletrue
T or F operative tx is always needed bimalleolar or trimalleolar fxT
operative tx necessary if isolated fx of lateral malleolus along medial clear space is > ? mm4mm
golden time for surgerybefore any true swelling or fx blisters develop
what should you do if the golden time for surgery has passeddelay surgery until resolution of the actue inflammation phase & edema(thought to lessen risk of wound complications)
AO/ASIF principles of ORIFAnatomical reduction of fx fragments, stable internal fixation, atraumatic surgical techhnique, early active ROM
when doing a lateral incision need to worry aboutsural & superficial peroneal nerves
how would you fixate a spiral fibular fxinterfragmentary compression screw(lag screw) oriented across fx from proximal ant to distal posterior
what type of lag screws can you use for a spiral fibular fx3.5 mm fully threaded cortical screw proximally and 4.0 fully threaded cancellous screw distally
how do you fixate lag screw to fibular1/3 tubular plate(neutralization plate)
rule of corticeswant 4-6 cortices proximal to fx & 2-4 cortices distal to fx
how would you repair a AITFL aka tibia(tillaux chaput) or fibula(wagstaffe) fxwith a single interfragmental compression screw(lag screw)
repair of deltoid ligno necessary if lateral malleolus has been properly restored to its anatomical alignment


Question Answer
DWA/SAD txintramedullary screw, tension band wire, hook plate,
SAD II (vertical medial malleolar fx) txfixate with 2 or more lag screws(partially threaded cancellous)
PAB III w/lateral comminution txfibula may require bridge plate fixation(comminution), locking plate
high fib fx(PER/DWC) txinterfragmentary screw, 1/3 tubular plate