ANKLE FRACTURES,Netbasert undervisning april 05,01,Illustrations redrawn from Malleolar Fractures and Soft Tissue Injuries of the ankle: Carr JB Ankle fractures: Marsch JL, Salzman CL,Composition: Bengt stman overlege Presentation: Simen Sellevold, assistentlege Ingo Spauke, assistentlege,Epidemiology,02,Incidence: 80130 per 100 000 persons highest in elderly women 67% isolated malleolar fractures 25% bimalleolar 8% trimalleolar,ANKLE FRACTURES,National Hospital Discharge Register of Finland 1994 Court-BrownCM, McBirnie J, Wilson G. Adult ankle fractures: an increasing problem? Acta Orthop Scand 1998;69:43-47,03,Incidence: Ringerike Hospital 1/8 2003 31/7 2004: 184 per 70 000 - 100 000 persons 128/184 (69%) isolated malleolar fractures 27/184 (15%) bimalleolar 29/184 (16%) trimalleolar,ANKLE FRACTURES,Epidemiology,04,ANKLE FRACTURES,Classification - Why?,Why do we require fracture classifications? for clinical research to understand the literature as an aid to fracture description as an aid to fracture treatment,05,AO (Danis/Weber) Type A below the syndesmosis Type B at the level of the syndesmosis Type C above the syndesmosis Danis R. Les fractures malleolaires. In: Danis R, ed. Thorie et practique de losteosynthse. 1949:133-165. Weber BG. Die Verletzungen des oberen Sprunggelenkes, Berne: Hans Huber, 1966. (2nd ed. 1972),Classification AO (Danis/Weber),ANKLE FRACTURES,06,AO AO/OTA (Weber) 3 types (A, B, C) 9 groups (A1, A2, A3, B1, B2, B3, C1, C2, C3) 27 subgroups Mller ME, Allgwer M, Schneider R, et al Manual of internal fixation, 2nd ed. Heidelberg: Springer-Verlag, 1979:282-299. (3rd ed. 1991). Orthopaedic Trauma Assocoation. Fracture and dislocation compendium. J Orthop Trauma 1996;10:1-55.,Classification AO/OTA,ANKLE FRACTURES,07,AO AO/OTA Lauge-Hansen Lauge-Hansen N. Fractures of the ankle: combined experimental-surgical and experimental roentgenologic investigations. Arch Surg 1950;60:957-985,Classification Lauge-Hansen,ANKLE FRACTURES,08,AO AO/OTA Lauge-Hansen Supination - External rotation (I, II, III, IV) Supination - Adduction (I, II) Pronation - External rotation (I, II, III, IV) Pronation - Abduction (I, II, III),position deforming force,Classification Lauge-Hansen,ANKLE FRACTURES,09,AO AO/OTA Lauge-Hansen Supination - External rotation (I, II, III, IV) Supination - Adduction (I, II) Pronation - External rotation (I, II, III, IV) Pronation - Abduction (I, II, III),position deforming force stable ”stable” unstable,Classification Lauge-Hansen,ANKLE FRACTURES,10,AO AO/OTA Lauge-Hansen Stable versus Unstable (Tile) Tile M. Fractures of the ankle. In: Joseph Schatzker MT, ed. The rationale of operative fracture care. Berlin: Springer-Verlag, 1987:371-404.,The presence or absence of a medial injury is the key to stability of the lateral malleolar fracture. The medial injury determines stability,Classification Stable/Unstable,ANKLE FRACTURES,11,Weber A,SA I-II,Weber B,SE I-IV,PA I-III,Weber C,PE I-IV,Danis Weber vs Lauge Hansen,ANKLE FRACTURES,Lauge-Hansen Classification (Supination-Adduction, SA I II),II,I,I Transverse fibula fracture or rupture of talofibular ligaments II Vertical medial malleolus fracture with a transverse distal fibula fracture and possible medial plafond fracture,ANKLE FRACTURES,12,Lauge-Hansen Classification (Supination-Adduction, SA I II,ANKLE FRACTURES,13,II,I,I Transverse fibula fracture or rupture of talofibular ligaments II Vertical medial malleolus fracture with a transverse distal fibula fracture and possible medial plafond fracture,Radiographic view: Supination-Adduction type II fracture with medial impaction,14,ANKLE FRACTURES,Radiographic view: Supination-Adduction type II fracture with medial impaction,15,ANKLE FRACTURES,Corrections Impression of medial plafond Reposition of medial malleolus Plating and bone grafting of medial metaphysis,Lauge-Hansen Classification (Supination-External rotation, SE I IV),II,I,III,IV,I Anterior tibial-fibular sprain II Stable short oblique fracture of the distal fibula III Rupture of posterior tibial-fibular ligament or fracture of the posterior margin IV Unstable short oblique fracture of the distal fibula with a medial malleolus fracture or a deltoid ligament disruption,ANKLE FRACTURES,16,Lauge-Hansen Classification (Supination-External rotation, SE I IV),II,I,III,IV,I Anterior tibial-fibular sprain II Stable short oblique fracture of the distal fibula III Rupture of posterior tibial-fibular ligament or fracture of the posterior margin IV Unstable short oblique fracture of the distal fibula with a medial malleolus fracture or a deltoid ligament disruption,ANKLE FRACTURES,17,Illustration: Supination-External rotation type II, III and IV,18,Fixation of an oblique fracture of the distal fibula,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV, (1 a),19,ANKLE FRACTUR