Transcript Ankle Fractures POTT’S FRACTURE

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:
1. Don’t delay.
2. Treat the bony and ligament injuries.
3. 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:
1. Lateral malleolus:
Perfect reduction and fixation by plate and
screws (most important step).
2. Medial malleolus:
Reduction after removing the periostium and
fixation by two malleolar screws.
3.
4.
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
1. Vascular injury: if fracture subluxation of the
ankle joint.
2. Wound breakdown and infection.
Late:
1. Malunion.
2. Non union (medial malleolus).
3. Stiffness.
4. Osteoarthrits.