To do this, emergency physicians need to employ stress radiographs to assess the stability of the ankle joint. 3 For this reason, assessing deltoid ligament integrity is of critical importance in determining the stability of an ankle fracture. 5Ĭlinical signs such as medial ankle pain, swelling, and ecchymosis are not reliable in identifying a deltoid ligament injury. 4 In what appears as an otherwise isolated Weber B fibular injury, a tear of the deltoid ligament can be considered “equivalent to a medial malleolar fracture,” qualifying the fracture mechanically as unstable, thus requiring operative management. A talar shift of 1 mm results in a 42 percent decrease in tibiotalar contact area, which can lead to significant increases in contact stress. The deltoid ligament, which runs from the medial malleolus to the calcaneus, talus, and navicular bones, plays a vital role in maintaining correct talus positioning. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular ligaments and the deltoid ligament. Any bi- or trimalleolar fracture should be considered unstable because of the disruption of the bony architecture on both the medial and lateral side of the joint. Unstable ankle fractures are one of the primary indications for orthopedic referral. In general, most stable ankle fractures can undergo nonoperative management by a primary care physician. The primary consideration regarding need for operative management of a closed ankle fracture is stability. The focus of this article is to help emergency physicians choose the proper method for determining that stability. 3 These type B fractures are sometimes stable, and patients can ambulate on them as tolerated in other cases, they are unstable and require open reduction and internal fixation (ORIF). Weber B fractures occur at the level of the tibiofibular ligaments, just above the talar dome, and happen primarily through a mechanism of ankle supination and external rotation (SER). This type of injury allows the talus to remain. (end of the fibula), medial malleolus (inside end of the tibia) or both, which is called. ![]() ![]() Ankle fractures are classified as stable if the fracture is non-displaced or minimally displaced and the medial structures (deltoid ligament and medial malleolus) are intact. The most common ankle fractures are breaks of the lateral malleolus. Weber C fractures are almost always unstable and require surgical intervention. The tibial plafond, lateral malleolus, and medial malleolus form a mortise, a socket in which the talus sits (Figure 2). ![]() Weber C fractures are above the ankle joint and are associated with a syndesmotic injury. Injuries to the distal fibula, below the talar dome, are classified as type A and are stable fractures. Tips for Diagnosing Occult Fractures in the Emergency DepartmentĮxplore This Issue ACEP Now: Vol 39 – No 04 – April 2020.Tips for Catching Commonly Missed Ankle Injuries The posterior malleolus is a component of the distal tibiofibular complex and is involved in and maintains ankle stability.Tips for Managing Suspected Occult Fractures.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |