31. Ankle fracture

Essay 31- Broken ankles

When the foot happens to fall into a forceful supination and adduction, a severe distortion can result with laceration of the fibular lateral ligaments
Or the external ankle may break off by way of a fragmentary mechanism with a transverse fracture line!

In forced supination and eversion, initially the collateral lateral ligaments are lacerated with or without fragmentation of a bony part
In the second stage- a torsion fracture occurs of the external ankle
In the third stage- subluxation of the talus and fracture of the posterior plateau of the tibia
In the fourth stage- fracture of the internal ankle

In pronation and abduction, deltoid ligament is lacerated and the medial malleolus may fracture at its tip
If the force is stronger, by way of a flexion mechanism, the external ankle is fractured
In predominant eversion, the tibia-fibular syndesmosis is broken down - high Dupuytren fracture
Or even higher fracture- Maisonneuve's fracture

Supination-adduction fractures- deformity of the ankle in varus with pathological mobility
Pronation abduction fractures- deformity is valgus of ankle
In laceration of syndesmosis- lateral size of ankle is wider
First aid
In dislocated fractures- approximate reduction and immobilizing in a boot splint
In open fractures- sterile dressing and immobilisation in dorsal plaster splint!
Treatment
Non-dislocated fractures- immobilization in the plaster boot lasts 35 days (for ext ankle) and 45 days (for int ankle)
In bi-malleolar fractures- 2 months
In tri-malleolar fractures- 3 months
Dislocated fractures- set under general anesthesia and immobilized!
Surgery- osteosynthesis with Kirschnerʼs needles using Weberʼs method!
Complications
Poor accretion or lack of accretion
Subsequently lead to severe deforming arthrosis!