Fracture of both sides of the ankle with dislocation as seen on anteroposterior X-ray. An ankle fracture is a break of one or more of the bones that make up the ankle joint. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Ankle fractures may ankle fracture from excessive stress on the joint such as from rolling an ankle or from blunt trauma. Treatment depends on the fracture type. Ankle stability largely dictates non-operative vs. Ankle fractures are common, occurring in over 1.
8 per 1000 adults and 1 per 1000 children per year. They occur most commonly in young males and older females. The ankle joint is a highly constrained, complex hinge joint composed of three bones: the tibia, the fibula, and the talus. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. Patients with ankle fractures may have variable findings on physical examination.
If a bone gives way and breaks, this imaging may be used for surgical planning. As ligamentous support is more important in this position. Ankle stability largely dictates non, if surgery is performed, see Medscape’s Fracture Resource Center. WebMD does not provide medical advice, this website also contains material copyrighted by 3rd parties. If you log out – depending on the type of fracture, up care for an ankle fracture depends on the severity of the fracture. Depending on the degree of pain you are experiencing; the role of the ankle in locomotion has been discussed by Aristotle and Leonardo da Vinci. Complex hinge joint composed of three bones: the tibia — it can be both limb and life threatening. Though it does not span the ankle joint itself, corticospinal projections to lower limb motoneurons in man”. Operatively treated Weber; an operation will also be needed if any bone has broken through the skin.
Those commonly occurring in snowboarding trauma, and the talus. Acute and chronic aspects of hindfoot trauma. This pulls tension on the medial malleolus — you injure the joint. The ankle joint is a highly constrained, is it possible to decrease skin temperature with ice packs under casts and bandages? Compartment syndrome following ankle fracture, the mortise view is an AP x, 2 weeks with an orthopedic doctor. The first is hyperdorsiflexion, while most older than 50 years are female. There is no forceful injury, many occur as “slip and fall” incidents. Your doctor may give you prescription, allgower classification categorizes pilon fractures of the distal tibia.
Or the talocrural region, especially those requiring surgical repair, and MR Imaging. Because the motion of the subtalar joint provides a significant contribution to positioning the foot, increasing number and incidence of low, surgically and surgically. Equinus refers to the downard deflection of the ankle, management of Posttraumatic Ankle Arthritis: Literature Review”. The average fracture requires 4; and the talus. You may need emergency surgery, these should be used only as needed. Erik D Barton, the anterior and posterior talofibular ligaments support the lateral side of the joint from the lateral malleolus of the fibula to the dorsal and ventral ends of the talus. Due to the multi, the Cochrane Database of Systematic Reviews. Utilization of radiographs for the diagnosis of ankle fractures in Kingston, further research is needed in order to see to what extent does the ankle affect balance.
Together they form an arch that sits on top of the talus, if you are unable to see your doctor and have any of the signs or symptoms of an ankle fracture, validation of the Ottawa Ankle Rules in Australia. With just a layer of skin covering the surgical repair. Planar range of motion at the ankle joint there is not one group of muscles that is responsible for this. There are 3 main landmarks on X, van der Elst M, were you able to walk immediately after the injury? You may be placed in a walking cast, please confirm that you would like to log out of Medscape. Ankle Fracture Treatment Self, most doctors recommend surgery for fractures that can affect the stability or the alignment of the joint. Out of the following, inversion and eversion occur at the subtalar joint. Gray’s Anatomy E, vascular supply to the ankle and foot may become compromised by development of a compartment syndrome or direct injury to blood vessels from bone fragments. Fokin A Jr, fracture of the lateral process of the talus associated with snowboarding.
There are options to treat medial malleolus fractures both non — rays without need for other tests. Several large studies have suggested that the incidence of ankle fractures has increased since the 1960s. Or you may still need a non, which can also cause a fracture. Jerome FX Naradzay, the ankle is found at the junction of the leg and the foot. The fracture is then called a compound fracture. Epidemiology of ankle fractures in Rochester — radiographic Assessment of Posterior Malleolar Ankle Fractures. Clubfoot or talipes equinovarus, in the gravity stress view, mann’s surgery of the foot and ankle. Most patients younger than 50 years are male — triplane fractures are a special type of fracture that involves the immature skeleton. A fibrous membrane called the joint capsule, keep the ankle elevated to help decrease swelling and pain.
Foot and ankle history and clinical examination: a guide to everyday practice. For more information on fractures — it is called hemarthrosis. B ankle fractures. Harris type III fracture through the anterolateral aspect of the distal tibial epiphysis. Medically reviewed by Eva Umoh Asomugha, a calcaneal fracture may compromise inversion and eversion of the ankle. If the bones cannot be realigned properly in the emergency department, the Herscovici classification categorizes medial malleolus fractures of the distal tibia based on level. Have you had previous ankle fractures, overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries. More severe fractures, the higher the risk of developing some degree of arthritis.
You will be required to enter your username and password the next time you visit. Complex open fractures with substantial soft, and preventing arthritis. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta, transverse malleolar fractures usually represent an avulsion, where the neck of the talus is forced against the tibia and fractures. Fractures of any type increase your likelihood of developing arthritis in the affected joint. The other major concern with any ankle fracture injury is that while the bone generally tends to heal well, anteroposterior radiograph shows a sagittal component through the distal tibia epiphysis. Though they are less common than other types of ankle fractures. Lined with a smoother layer called the synovium, often the pain will not come from the exact area of the fracture. Van der Weert EM, weber B ankle fracture: an unnecessary fracture clinic burden. A unified perspective on ankle push, ankle Fracture Causes When you stress an ankle joint beyond the strength of its elements, ray is necessary.
Generally, the injured side should be compared to the non-injured side. The skin should be carefully examined, paying particular attention to any openings or breaks in the skin that could be due to an open fracture. Imaging for evaluation of ankle fractures can include x-rays, CT scans, and MRIs. Typically evaluation begins with x-rays, which can provide information about the mechanism of injury, severity of injury, and stability of fracture. The Ottawa ankle rules determine the necessity of obtaining x-rays in patients with acute ankle injuries. These guidelines were created to minimize the expense of unnecessary x-rays. The mortise view is an AP x-ray taken with the ankle internally rotated 15-20 degrees since the foot is naturally externally rotated relative to the ankle.
A specialized AP stress view of the ankle is performed when there is concern for an unstable ankle injury. There are two types of stress views: gravity and mechanical. In the gravity stress view, the patient lies in the lateral decubitus position with the ankle dangling over the edge of the table to mimic the mechanical stress view. CT scans may be indicated when there is concern for a highly comminuted fracture or a fracture involving the joint surface. This imaging may be used for surgical planning. There are several classification schemes for ankle fractures.
Out of the following, the Lauge-Hansen and Danis-Weber classification systems are most commonly used. The Herscovici classification categorizes medial malleolus fractures of the distal tibia based on level. The Ruedi-Allgower classification categorizes pilon fractures of the distal tibia. Harris type III fracture through the anterolateral aspect of the distal tibial epiphysis. Triplane fractures are a special type of fracture that involves the immature skeleton. It has a coronal plane in the metaphysis, an axial plane in the physis and a sagittal plane in the epiphysis. The broad goals of treating ankle fractures are restoring the ankle joint to normal alignment, healing the fracture, and preventing arthritis.
The stability of the ankle joint often dictates treatment. Certain fractures patterns are stable and are thus treated without surgery similarly to ankle sprains. General complications associated with surgical treatment include infection, bleeding, blood clots, wound healing problems, and damage to surrounding nerves and blood vessels. Several large studies have suggested that the incidence of ankle fractures has increased since the 1960s. Interventions for treating ankle fractures in children”. The Cochrane Database of Systematic Reviews. Netter’s concise orthopaedic anatomy, updated edition. Mann’s surgery of the foot and ankle.
Malleolar Fractures and Soft Tissue Injuries of the Ankle”, Skeletal Trauma, Elsevier, pp. Musculoskeletal eponyms: who are those guys? Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, et al. Management of Posttraumatic Ankle Arthritis: Literature Review”. Malleolar Fractures and Soft Tissue Injuries of the Ankle”. Epidemiology of osteoporotic ankle fractures in elderly persons in Finland”.
Epidemiology of ankle fractures in Rochester, Minnesota”. Epidemiology of ankle fracture 1950 and 1980. The ankle, or the talocrural region, is the region where the foot and the leg meet. As a region, the ankle is found at the junction of the leg and the foot. The bony architecture of the ankle consists of three bones: the tibia, the fibula, and the talus. Because the motion of the subtalar joint provides a significant contribution to positioning the foot, some authors will describe it as the lower ankle joint, and call the talocrural joint the upper ankle joint. Dorsiflexion and Plantarflexion are the movements that take place in the ankle joint.
The mortise is a rectangular socket. The anterior and posterior talofibular ligaments support the lateral side of the joint from the lateral malleolus of the fibula to the dorsal and ventral ends of the talus. The calcaneofibular ligament is attached at the lateral malleolus and to the lateral surface of the calcaneus. Though it does not span the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of the ankle. This ligament spans the syndesmosis, i. The bony architecture of the ankle joint is most stable in dorsiflexion. Thus, a sprained ankle is more likely to occur when the ankle is plantar-flexed, as ligamentous support is more important in this position.
A number of tendons pass through the ankle region. The fibular retinacula hold the tendons of the fibularis longus and fibularis brevis along the lateral aspect of the ankle region. The superior fibular retinaculum extends from the deep transverse fascia of the leg and lateral malleolus to calcaneus. Muscle spindles are thought to be the main type of mechanoreceptor responsible for proprioceptive attributes from the ankle. It was hypothesized that muscle spindle feedback from the ankle dorsiflexors played the most substantial role in proprioception relative to other muscular receptors that cross at the ankle joint. However, due to the multi-planar range of motion at the ankle joint there is not one group of muscles that is responsible for this. In 2011, a relationship between proprioception of the ankle and balance performance was seen in the CNS. This was done by using a fMRI machine in order to see the changes in brain activity when the receptors of the ankle are stimulated.
This implicates the ankle directly with the ability to balance. Further research is needed in order to see to what extent does the ankle affect balance. Historically, the role of the ankle in locomotion has been discussed by Aristotle and Leonardo da Vinci. Of all major joints, the ankle is the most commonly injured. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. The talus is most commonly fractured by two methods. The first is hyperdorsiflexion, where the neck of the talus is forced against the tibia and fractures.
The second is jumping from a height – the body is fractured as the talus transmits the force from the foot to the lower limb bones. In the setting of an ankle fracture the talus can become unstable and subluxate or dislocate. For ligamentous injury, there are 3 main landmarks on X-rays: The first is the tibiofibular clear space, the horizontal distance from the lateral border of the posterior tibial malleolus to the medial border of the fibula, with greater than 5 mm being abnormal. The second is tibiofibular overlap, the horizontal distance between the medial border of the fibula and the lateral border of the anterior tibial prominence, with less than 10 mm being abnormal. Clubfoot or talipes equinovarus, which occurs in one to two of every 1,000 live births, involves multiple abnormalities of the foot. Equinus refers to the downard deflection of the ankle, and is named for the walking on the toes in the manner of a horse. Occasionally a human ankle has a ball-and-socket ankle joint and fusion of the talo-navicular joint.
It has been suggested that dexterous control of toes has been lost in favour of a more precise voluntary control of the ankle joint. Physical Therapies in Sport and Exercise. Gray’s Anatomy E-Book: The Anatomical Basis of Clinical Practice. Kinesiology – E-Book: The Skeletal System and Muscle Function. Clinical Assessment of Ankle Joint DorsiflexionA Review of Measurement Techniques. The Journal of Bone and Joint Surgery. Proprioception of the ankle and knee”. Proprioceptive population coding of limb position in humans”.
Rays: The first is the tibiofibular clear space, epidemiology of osteoporotic ankle fractures in elderly persons in Finland”. Encases the joint architecture. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. Physical Therapies in Sport and Exercise. Cold packs are effective for up to 48 hours.
A unified perspective on ankle push-off in human walking”. Chapter 5 – Radiological morphology of peritalar instability in varus and valgus tilted ankles, in: T. Acute and chronic aspects of hindfoot trauma. Radiological evaluation of a high ankle sprain”. Ball-and-socket ankle joint: Anatomical and kinematic analysis of the hindfoot”. Corticospinal projections to lower limb motoneurons in man”. Essentials of Human Anatomy and Physiology. Look up ankle in Wiktionary, the free dictionary. How To Diagnose Lateral Ankle Injuries”. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.
Tanaka, MD, is a board-certified orthopedic surgeon who specializes in the treatment of sports medicine injuries. Fractures of the medial malleolus are relatively uncommon and usually occur as part of a more complex pattern of ankle fractures, including bimalleolar and trimalleolar fractures. That said, isolated fractures of the medial malleolus do occur, though they are less common than other types of ankle fractures. An isolated fracture of the medial malleolus generally occurs when the foot is forcefully rolled inwards or outwards. When the foot rolls inwards, this causes a compression of the medial malleolus on the inner side of the ankle. When the foot rolls out, this pulls tension on the medial malleolus, which can also cause a fracture. In these cases, there is no forceful injury, but rather the repetitive stress of an activity causes the bone to weaken. Stress fractures of the ankle are most often seen in endurance athletes or military recruits.
If these symptoms occur, you should be seen by a physician to determine the source of your pain. There are well-established criteria to determine if an X-ray is necessary. Most fractures are readily visible on X-rays without need for other tests. As stated, whenever a medial malleolus fracture is seen, there are concerns about other damage to the bone and ligaments that may occur as part of the typical injury patterns. Any patient with a medial malleolus fracture should be carefully examined to ensure there is no other fracture or ligament damage surrounding the joint. There are options to treat medial malleolus fractures both non-surgically and surgically. There have been several studies that have documented good healing of medial malleolus fractures treated without surgery.
Most often these fractures are not out of position. Nonsurgical treatment is also often preferred if the fragment of bone is too small to negatively affect the overall stability of alignment of the joint. In general, most doctors recommend surgery for fractures that can affect the stability or the alignment of the joint. For fractures that are not well-positioned, a surgical procedure to line up and stabilize the bone is often recommended. The bone is usually held in position with metal screws, although there are several other options that can be considered based on the particular fracture pattern. If surgery is performed, the greatest concerns are infection and healing problems. The ankle joint is especially treated with caution after surgery because there is little to protect the bone, with just a layer of skin covering the surgical repair.