Ankle Fractures POTT’S FRACTURE

Malleolar Fractures Injuries about the ankle joint cause destruction of not only the bony architecture but also often of the ligamentous and soft tissue components.

Anatomy

Mechanism of injury The patient stumbles and falls with the foot anchored to the ground and the body with the ankle joint twists.

Mechanism of injury There may be fracture of one or both malleoli or one malleolus and the opposite ligaments. If the malleolus pushed the fracture is oblique; if its pulled the fracture is transverse.

Danis -Weber classification Based on the location and appearance of the fibular fracture: Type A: caused by internal rotation and adduction that produce a transverse fracture of the lateral malleolus at or below the plafond, with or without an oblique fracture of the medial malleolus.

Type B: caused by external rotation that results in an oblique fracture of the lateral malleolus. The injury may include rupture or avulsion of the anteroinferior tibiofibular ligament, fracture of the medial malleolus, or rupture of the deltoid ligament.

Type C: fractures are abduction injuries with oblique fracture of the fibula proximal to the disrupted tibiofibular ligaments ;medial malleolar fracture or a deltoid ligament rupture. Fracture of the posterior malleolus may accompany type C fractures.

Clinical features Skiers, footballers, climbers and RTA. Pain, inability to stand, swelling, deformity, echymoses and skin blistering.

X-ray: AP, lateral, 30° oblique views of the ankle (mortise). Lateral and medial malleolus, posterior tibial edge (posterior malleolus), tibio fibular syndesmoses (diastases).

Treatment Principles: Don’t delay. Treat the bony and ligament injuries. Accurate reduction and maintaining it. Conservative treatments: Used for non displaced type A and B injuries. Below knee posterior slab for 5 days with elevation, then check X-ray if still non displaced full POP cast for 6-8 weeks.

Operative treatments: For displaced type A& B and all type C Injuries. Open reduction and internal fixation in steps: Lateral malleolus: Perfect reduction and fixation by plate and screws (most important step). Medial malleolus: Reduction after removing the periostium and fixation by two malleolar screws.

Transverse screw if the syndesmoses is unstable. Posterior malleolus if large fix by one screw.

Postoperative treatment: Below knee posterior slab for 5 days with elevation, followed by full POP walking cast for 6-8 weeks. Complications: Early Vascular injury: if fracture subluxation of the ankle joint. Wound breakdown and infection. Late: Malunion. Non union (medial malleolus). Stiffness. Osteoarthrits.