UMP

Ankle fractures:
injury mechanisms and classification

H. D. Thai
N. V. Nhuan

Date: Aug 19, 2022

AOA Foot and Ankle Fracture
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Lauge-Hansen Classification

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 SER II SER IV - Bone SER IV - Ligament

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 Operate or not?

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 Stable Unstable

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 Talar shift = Unstable
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 Unstable SER ankle fracture
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 Unstable SER ankle fracture
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 Stable or Unstable?
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Initial Xray

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 Plantarflexed in ER
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 Detoid ligament’s relaxed Shape of Talus
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 Plantarflexed Xray in ER Plantigrade WB Xray
Gougoulias, N., & Sakellariou, A. (2017). When is a simple fracture of the lateral malleolus not so simple? How to
UMP assess stability, which ones to fix and the role of the deltoid ligament. The bone & joint journal, 99(7), 851-855.
Initial Xray is unreliable
Medial tenderness

Stenquist, D. S., Miller, C., Velasco, B., Cronin, P., & Kwon, J. Y. (2020). Medial tenderness revisited: Is medial ankle
UMP tenderness predictive of instability in isolated lateral malleolus fractures?. Injury, 51(6), 1392-1396.
Deltoid ligament

Savage-Elliott, I., Murawski, C. D., Smyth, N. A., & Kennedy, J. G. (2013). The deltoid ligament: an in-depth review of
UMP anatomy, function, and treatment strategies. Knee Surgery, Sports Traumatology, Arthroscopy, 21(6), 1316-1327.
Medial tenderness, swelling, ecchymosis is unreliable
Gravity stress test

Dawe, E. J., Shafafy, R., Quayle, J., Wee, A. (2015). The effect of different methods of stability assessment on fixation
UMP rate and complications in supination external rotation (SER) 2/4 ankle fractures. Foot and Ankle Surgery, 21(2), 86-90.
Gravity stress test

Dawe, E. J., Shafafy, R., Quayle, J., Wee, A. (2015). The effect of different methods of stability assessment on fixation
UMP rate and complications in supination external rotation (SER) 2/4 ankle fractures. Foot and Ankle Surgery, 21(2), 86-90.
Gravity stress test

Painful

Over-estimates
instability

Dawe, E. J., Shafafy, R., Quayle, J., Wee, A. (2015). The effect of different methods of stability assessment on fixation
UMP rate and complications in supination external rotation (SER) 2/4 ankle fractures. Foot and Ankle Surgery, 21(2), 86-90.
 Walking boot
Kearney, R., McKeown, R., Parsons, H., Haque, A., Parsons, N., ... & Costa, M. (2021). Use of cast immobilisation
UMP versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial. bmj, 374.
Axial loading of stable fracture
makes it more stable not less

WBAT
Kearney, R., McKeown, R., Parsons, H., Haque, A., Parsons, N., ... & Costa, M. (2021). Use of cast immobilisation
UMP versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial. bmj, 374.
Weight bearing Xray after 1 week

Weber, M., Burmeister, H., & Krause, F. G. (2010). The use of weightbearing radiographs to assess the stability of
UMP supination-external rotation fractures of the ankle. Archives of orthopaedic and trauma surgery, 130(5), 693-698.
 Unstable fracture
Weber, M., Burmeister, H., & Krause, F. G. (2010). The use of weightbearing radiographs to assess the stability of
UMP supination-external rotation fractures of the ankle. Archives of orthopaedic and trauma surgery, 130(5), 693-698.
 Stable fracture
Weber, M., Burmeister, H., & Krause, F. G. (2010). The use of weightbearing radiographs to assess the stability of
UMP supination-external rotation fractures of the ankle. Archives of orthopaedic and trauma surgery, 130(5), 693-698.
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 SPAN - SCAN - PLAN
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 Wait 10 -14 days

Wrinkle sign

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Take home messages

▪ SER injury: stable or unstable

▪ SAd injury: impaction
▪ PER: PM + syndesmosis
▪ PAb injury: soft tissue

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THANK YOU FOR YOUR ATTENTION