5.9 E) Xii) Orthopaedics Ankle Fractures

Front 1

What is the "third" malleolus?

Back 1

Posterior margin of the distal tibia

Front 2

What is the name given to the Classification

System for ankle fractures?

Back 2

"The Lauge-Hansen classification"

Front 3

Which mechanism of injury,as per the "Lauge-Hansen" classification, is the most common for ankle fractures?

Back 3

"SER" 60%

Supination (Inversion) External rotation

Front 4

List the Stages of the Lauge-Hansen

classification system- and the relative

occurrence

Back 4

SER [1-4] 60%
PER [1-4] 20%
SAD [1-2] 20%
PAB [1-3] <0.5%

Front 5

Which fractures are not included in the Lauge-Hansen Classification for ankle fractures?

Back 5

Tibial plafond {pylon fractures}

-axial compression #

Front 6

Which is incorrect regarding Adduction

[ Inversion ] injuries to the ankle?
1. They mostly cause a sprain of the anterior TALOFIBULAR ligament.
2. They are responsible for 50% of ankle fractures

3. One type of adduction ankle fracture is the horizontal lateral

malleolus fracture below the level of the mortice [ Weber A ]
4. Another type of adduction fracture is an oblique fracture through the medial malleolus.

5. The Adduction injuries are also called "supination-adduction" [SAD] , or inversion injuries.

Back 6

2. Supination-Adduction ankle injuries = 20%

Front 7

In regards to the Lauge-Hansen Ankle injuries, which is incorrect?
1. External rotation is responsible for 80% of ankle - malleolar fractures
2. In 20% of malleolar fractures, the foot is SUPINATED [ inverted ] at the time of external rotation

3. with SER [supination-external rotation] injuries, there can be a spiral fracture of the lateral malleolus at or above the mortice [ Weber B or C ] 4. With SER injuries, There can be tearing of the posterior inferior tibiofibular ligament

5. With SER injuries, There can be an avulsion fracture of the posterior margin of the distal tibia [posterior malleolus]

Back 7

2. 60% = SER #

1. = SER + PER

Front 8

What is the common injury type [as per lauge-Hansen ] seen with fracture dislocations of the ankle, reduced in the ED prior to imaging?

Back 8

SER 4
Supination external rotation

1. Tear of AITFL
2. Spiral # of lateral malleolus above mortice
3. tear of PITFL OR posterior malleolar #
4. # of medial malleolus OR deltoid ligament tear

Front 9

Danis-Weber Classification of Lateral

malleolar ankle fractures

Back 9

Weber A : # below mortise -usually no surgery

[ unless medial malleolus # also ]
Weber B ; # at the level of the mortise

- usually surgery 50% of time
Weber C : # Above the level of the mortise -NEARLY ALWAYS REQUIRES SURGERY due to distal tibiofibular ligament being disrupted.

Front 10

Which of the Weber classifications of ankle

fractures requires surgery?

Back 10

1. Weber A - if additional medial malleolar #
2. Weber B : 50% of time
3. Weber C -most

Front 11

Weber and Lauge -Hansen classification

correlation relationship?

Back 11

Weber A = Supination-adduction

[ inversion ; 20% injuries ]
Weber B = Supination-external rotation

[SER ; 60% injuries ]
Weber C = Pronation-external rotation

[ PER ; 20% ]

Front 12

The Maisonneuve Fracture complex includes what combination of injuries?

Back 12

1. Proximal oblique fibular #
2. disruption of distal tibiofibular ligament
3. Medial malleolar #
OR
deltoid ligament tear
4. +/- Interosseous membrane tear

Front 13

What 3 views are typical of an ankle series of XR?

Back 13

1. AP
2. Lateral
3. Mortise view : AP view with 15 degrees

internal rotation

Front 14

Which is incorrect regarding ankle XR?
1. The distal talofibular joint is the "ankle syndesmosis".
2. The mortise view is key to assessing the structural integrity of the

ankle.
3. The entire mortise joint space adjacent to the talar dome should be of uniform width.
4. The distal tibiofibular joint space should be ONLY SLIGHTLY WIDER than the mortise joint space.
5. Lack of tibiofibular overlap on mortise view implies DISRUPTION OF THE TIBIOFIBULAR JOINT.

Back 14

1. Distal TIBIOFIBULAR joint

= Ankle Syndesmosis

Front 15

What is the incidence of Maisonneuve

ankle #?

Back 15

5% of ankle fractures

Front 16

True / false:

A Maisonneuve # should be considered

whenever there is :
1. Fracture / ligamentous injury to the lateral

ankle

2. Widening of the distal tibiofibular joint

without lateral malleolar #

Back 16

False:

1. # / ligament injury to MEDIAL ankle
2. widening of the distal tibiofibular joint without lateral malleolar #