Patients with ankle fractures may have variable findings on physical examination. Ankle anatomy Diagnosis Physical Examination This is known as an open fracture and has a high incidence of infection if not promptly treated. The sharp fragments of broken bone sometimes tear the skin and form a laceration that communicates with the broken bone or joint space. In a displaced, fracture the skin is sometimes tented over a sharp edge of broken bone. Patients may notice ecchymosis ("black and blue" coloration from bleeding under the skin), or there may be an abnormal position, alignment, gross instability, or lack of normal motion secondary to pain. However, in the setting of an ankle fracture, the talus can become unstable and subluxate or dislocate. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. Symptoms of an ankle fracture can be similar to those of ankle sprains (pain, swelling, limited range of motion), though typically they are often more severe by comparison. The distal parts of the tibia and fibula are connected by a connective tissue network referred to as the syndesmosis, which consists of four ligaments and the interosseous membrane. It prevents the foot from excessively everting, or turning outwards while also preventing the talus from externally rotating. The deltoid ligament provides support to the medial part of the ankle (closest to the midline). The calcaneofibular ligament (CFL), which connects the fibula to the calcaneus, or heel bone, also provides lateral support. These ligaments include the anterior talofibular ligament (ATFL) and the posterior talofibular ligament (PTFL). The talus and the fibula are connected by a strong group of ligaments, which provide support for the lateral aspect of the ankle. Together the tibia and fibula form a bracket-shaped socket known as the mortise, into which the dome-shaped talus fits. This articulation (where two bones meet) is primarily responsible for plantarflexion (moving your foot down) and dorsiflexion (moving your foot up). The weight-bearing aspect of the tibia closest to the foot (known as the plafond) connects with the talus. The ankle joint is a highly constrained, complex hinge joint composed of three bones: the tibia, the fibula, and the talus. The ankle region refers to where the leg meets the foot (talocrural region). They occur most commonly in young males and older females. Īnkle fractures are common, occurring in over 1. Significant recovery generally occurs within four months while completely recovery usually takes up to one year. Non-operative treatment includes splinting or casting while operative treatment includes fixing the fracture with metal implants through an open reduction internal fixation ( ORIF). Ankle stability largely dictates non-operative vs. Special X-ray views called stress views help determine whether an ankle fracture is unstable. The Ottawa ankle rule can help determine the need for X-rays. Types of ankle fractures include lateral malleolus, medial malleolus, posterior malleolus, bimalleolar, and trimalleolar fractures. Īnkle fractures may result from excessive stress on the joint such as from rolling an ankle or from blunt trauma. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Rheumatoid arthritis, gout, septic arthritis, Achilles tendon rupture Īn ankle fracture is a break of one or more of the bones that make up the ankle joint. Lateral malleolus, medial malleolus, posterior malleolus, bimalleolar, trimalleolar High ankle sprain, compartment syndrome, decreased range of motion, malunion Pain, swelling, bruising, inability to walk (1) fibula, (2) tibia, (arrow) medial malleolus, (arrowhead) lateral malleolus Fracture of both sides of the ankle with dislocation as seen on anteroposterior X-ray.
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