Ankle Fractures - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University
devaki
devaki21 December 2012

Ankle Fractures - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University

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Ankle Fractures, Osteopenic Bone, Finnish Study, Twisting of Foot, Ankle Trauma Series, Length of Fibula, Malleolar Fracture, Disruption of Syndesmotic Ligaments are some points from this lecture. This lecture is for Ort...
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Ankle Fractures

Ankle Fractures

• Common injury in the elderly – Significant increase in the

incidence and severity of ankle fractures over the last 20 years

• Low energy injuries following twisting reflecting the relative strength of the ligaments compared to osteopenic bone

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Ankle Fractures

• Epidemiology – Finnish Study (Kannus et al)

• Three-fold increase in the number of ankle fractures among patients older than 70 years between 1970 and 2000

• Increase in the more severe Lauge-Hansen SE-4 fracture – In the United States, ankle fractures have been reported to

occur in as many as 8.3 per 1000 Medicare recipients • Figure that appears to be steadily rising.

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Ankle Fractures • Presentation

– Follows twisting of foot relative to lower tibia – Patients present unable to bear weight – Ecchymosis, deformity – Careful neurovascular exam must be

performed

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Ankle Fractures

• Radiographic evaluation – Ankle trauma series

includes: • AP • Lateral • Mortise

– Examine entire length of the fibula

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Ankle Fractures • Treatment

– Isolated, non-displaced malleolar fracture without evidence of disruption of syndesmotic ligaments treated non-operatively with full weight bearing

– My utilize walking cast or cast brace

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Ankle Fractures

• Treatment – Unstable fracture patterns with bimalleolar

involvement, or unimalleolar fractures with talar displacement must be reduced

– Treatment closed requires a long leg cast to control rotation

• may be a burden to an elderly patient

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Ankle Fractures

• Treatment – Reductions that are unable to

be attained closed require open reduction and internal fixation

– The skin over the ankle is thin and prone to complication

– Await resolution of edema to achieve a tension free closure

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Ankle Fractures

• Treatment – Fixation may be suboptimal due to osteopenia

• May have to alter standard operative techniques • Cement Augmentation

– Reports in literature mixed • Early studies showed no difference in operative vs non-op

treatment -- with operative groups having higher complication rates

• More recent studies show improved outcomes in operatively treated group

– Goal is return to pre-injury functional status

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