Ankle & Foot fractures

Ankle Fractures

Epidemiology and Mechanism

• Incidence increased in elderly women
• Most are isolated malleolar fractures
• Mechanism of injury:
  • Position of the foot at time of injury
  • Magnitude, direction, and rate of loading

Evaluation

• Clinical
• A dislocated ankle should be reduced and splinted immediately (before radiographs) if clinically evident
• Radiographic
  • AP, Lateral and
  • Mortise views

Radiographic Views

• AP view
  • Tibiofibula overlap of <10 mm is abnormal:
    • Syndesmotic injury
  • Tibiofibula & /Tibiofibula/ media clear space of >5 mm is abnormal:
    • Syndesmotic injury
  • Talar tilt

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• Lateral view
  • The dome of the talus should be centered under the tibia and congruous with the tibial plafond
  • Posterior tibial malleolus fractures can be identified

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• Mortise view
  • Ap with foot in 15° of internal rotation
  • A medial clear space
    • Tibiofibular overlap
    • Talar shift

Important to assess syndesmotic injury

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Ankle views

• AP, Lateral, and Ankle mortise views

Classification and Treatment

• Denis -Weber classification
  • Based on fibular fracture:
    • A. Infra-syndesmotic
    • B. Trans-syndesmotic
    • C. Supra-syndesmotic:
      • usually syndesmosis is torn

Mechanism of injury

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• Treatment
  • Undisplaced:
    • Below knee cast (NWB)
  • Indications for ORIF
    • All fracture-dislocations
    • All type C fractures
    • Tri-malleolar fractures
    • Talar shift or tilt
    • Failure to achieve or/maintain closed reduction

Decision-making and stability

Operative

Complications

• Post traumatic arthritis
• Stiffness
• Skin necrosis
• Malunion / Nonunion
• Wound infection
• Complex regional pain syndrome

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Fractured Talus

Complications: AVN

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Calcaneal Fractures

Mechanism and Associated Injuries

• Fall from height
• Associated injuries – must always exclude
  • Fracture neck femur
  • Compression of spine

Imaging

• X-rays: Lat, & Axial view
• CT scan: shows details

Treatment

• Treatment:
  • Conservative
    • Extra-articular fractures
    • Undisplaced fractures
    • Severely comminuted
    • No expertise
  • Operative
    • Intra-articular fractures

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Metatarsal Fractures

Epidemiology and Types

• Common
  • Sport injury / others
  • 5th is the commonest
  • followed by 1st & 2nd
• Types:
  • Acute trauma / Stress
  • Closed / Open

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5th Metatarsal Fractures

• Types: Avulsion – Base – Shaft - Neck

Treatment

• Treatment
  • Usually conservative
  • May need surgery if unstable and multiple