Ankle Fracture

Bagas Widhiarso
 Introduction

Described as fracture of fibula 2 to 3 inches

above the distal tip, with associated rupture of
medial ligaments and lateral subluxation of the
talus. (Pott)
 Anatomy

Ankle is a complex joint

Consist of functional
articulation :
Tibia fibula
Tibia talus
Fibula talus
The shape of the joint provide
intrinsic stability especially in
weight bearing
 Anatomy

Three distinct group of

ligament support ankle joint :

Syndesmotic lig

Lateral collateral

Medial collateral
Anatomy
 Anatomi
1/6 body weight
tranfered to fibular
maleolar
 Classification

Danis-Weber
classification
Based on the location
and appearance of
the fibular fracture
 Classification

Lauge-Hansen classification
Based on mechanism of injury
The first word in the designation refers to the
foots position at the time of injury; the
second word refers to the direction of the
deforming force
 SUPINATION-ADDUCTION (SA)

Transverse avulsion-type
fracture of the fibula
below the level of the joint
or tear of the lateral
collateral ligaments
Vertical fracture of the
medial malleolus
 SUPINATION- EXTERNAL ROTATION
Disruption of the
anterior tibiofibular
ligament
Spiral oblique fracture
of the distal fibula
Disruption of the
posterior tibio fibular
ligament or fracture of
the posterior malleolus
Fracture of the medial
malleolus or rupture of
the deltoid ligament
 PRONATION-ABDUCTION (PA)

Transverse fracture of the

medial malleolus or
rupture of the deltoid
ligament
Rupture of the
syndesmotic ligaments or
avulsion fracture of their
insertion(s)
Short, horizontal, oblique
fracture of the fibula
above the level of the joint
 PRONATION - EXTERNAL
ROTATION)
Transverse fracture of the
medial malleolus or disruption
of the deltoid ligament
Disruption of the anterior
tibiofibular ligament
Short oblique fracture of the
fibula above the level of the
joint
Rupture of posterior
tibiofibular ligament or
avulsion fracture of the
posterolateral tibia
 Treatment

Consist of :
non operative
operative treatment

The goal of treatment are :

Obtain an anatomical reduction
Restore into painless,stable, and mobile ankle
 Non Operative
The indication are :
Non dispaled fracture
Displace fracture that closed anatomical reduction can be
achieved
Patient general status isnt good undergo operation

Closed reduction is obtained by reversing the

mechanism of injury
Immobilized the reduction with bulky dressing, LLC, BKC
Maintain until 4-6 weeks
 Operative
Recommended for :
Failure of close reduction

Displace and unstable fracture

Open fracture

Choice /method of fixation are :

Screwing

Figure of eight fixation

Plate and screw

 Surgical Approach

Lateral
Medial
posterolateral
 Surgical Technique
Usually the distal fragment of the medial malleolus is
displaced distally and anteriorly, and a small fold of
periosteum common
With a bone-holding clamp or towel clip,bring the
detached malleolus into normal position and, while
holding it there, internally fix it with two 2-mm smooth
Kirschner wires and insert the lag srew
 After Treatment

Antibiotics : induction anesthesia 48 hours post-op

Range-of-motion exercises are started as the pain

subside

Weight-bearing is restricted for 6 weeks

Full weight-bearing is allowed after 12 weeks.

Thank You