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Ankle Fractures – Everything You Need To Know

There are a lot of important topics associated with ankle fractures.
An important topic is the classification of anchored fractions. There are two standard classifications used for ankle fractures:
.Weber Classification
ankle fractures are classified according to the level of the fibula fracture. (fracture below the syndesmosis, fracture at the syndesmosis, fracture above the syndesmosis)
.Lauge Hansen Classification

1. Weber Classification

Weber type A: Fracture below the level syndesmosis. Fracture is rarely unstable and is seldom associated with syndesmotic injury.
Weber type B: Common injury, fracture occurs at the level of the syndesmosis, and fracture could be unstable.
Weber type C: The Fracture occurs above the level of the syndesmosis, and the fracture is usually unstable. 

Ankle Fractures

Type C fracture with deltoid ligament injury with this fracture will most likely require syndesmotic screws. We need cinders because the syndesmosis will be inconsistent. The higher the fracture level, the more likely it will need syndesmotic screws.

2. Lauge Hansen classification

Depends on the mechanism of the injury. The Weber classification depends on the level of the fibular fracture.
Depending on two things, the position of the foot was pronation or supination.
The second mechanism is the force applied. Is it adduction, abduction or external rotation?
Because of these two components, the position of the foot and the force applied, we got four types in the leg Hanson classifications.
Along with supination or pronation, adduction, abduction or external rotation are involved in the fracture mechanism of injury.
1. Supination – Adduction
. Vertical medial malleolus fracture associated with injury to the talus and tibial Plafond.
. Movement of the talus medially.
. Possible anteromedial tibial plafond impaction.
. transverse fracture of the distal fibula.
This classification injury type often appears in exam questions about its fixation method!
Treatment
Screws parallel to the ankle joint or Anti-gliding plate
. check for loose bodies in common due to possible tibial plafond impaction.
. May also need to elevate and restore the joint surface.
. Fixation for this injury type may need to be started medially rather than laterally (first).
1. Supination – External Rotation
. Most common injury how to do
. When looking at a fracture, you want to classify and check the fibula
on the lateral X-ray.
. Always look for this injury type on AP view and Lateral view radiographs.
. On lateral X-ray, if you find a fibular fracture that starts from anterior/inferior going posterior /superior, this is supination – external rotation injury.
. This is the injury type that can give you trouble if the fibula appears to be the only one that’s fractured because you want to prove that this is a Supination – external rotation injury type 2 and not a type 4 injury.
. Make sure that you are not missing a type 4 fracture of the medial malleolus or injury to the deltoid ligament.
This injury type has four stages:
1.Anterior Tibiofibular Ligament
2. Fibula Fracture
3. Posterior Tibiofibular Ligament
4. Medial Malleolus or Deltoid Ligament
No fracture of the medial malleolus but a tear of the deltoid ligament.
A deltoid ligament injury may not show up clearly on X – rays.

3. Pronation External – Rotation
In this case, the fracture goes from anterior/superior to posterior/inferior, and the fracture is usually above the joint level (Weber type C). This fracture has four stages starting medially. The fracture pattern moves in a circle similar to the supination – external rotation injury.
4. Pronation Abduction
fracture of the fibula usually is transverse or comminuted. The fractured ankle may have injury only to the syndesmosis with nothing else appearing on the x-ray. This fracture starts medially and may cause damage to the deltoid ligament. Damage to the syndesmosis and fracture of the fibula will occur last.

Ankle Fracture Surgery

If a person breaks their ankle and the bones no longer line up, a doctor may need to perform a surgical procedure to reposition and secure the bones.
The ankle is the joint that connects the leg and the foot. The ankle joint includes the two lower leg bones called the tibia and fibula and the ankle bone called the talus.
Together, the end of the tibia and fibula create a Wharton or “slot” for the talus, forming the ankle joint’s bottom.
Tissues called ligaments and tendons support the ankle bones. Ligaments attach bones to bones, and tendons attach muscles to bones. The ankle joint allows the foot to move up and down. Ankle injuries usually happen during athletic activities, falls, or car accidents.
The most common type of ankle fractures occurs when the foot turns inward and the ankle rotates outward.
If the ankle fractures are stable, the pieces of bone still line up in their normal position. In any fracture, more than one bone may break. In a displaced fracture, the details of bone no longer line up.
If the bone breaks through the skin, it’s a compound or “open” fracture.
In addition to broken bones, the ankle may be sprained. This means the ligaments have been stretched or torn. If the ankle is very swollen, the surgeon may delay a surgical procedure to allow the swelling to go down. During this time, the surgeon may put the ankle in a splint to provide support. During this time, the surgeon may recommend elevating the ankle above the level of the heart and applying ice to it.
To treat a stable ankle fracture, the healthcare provider may put the leg in a cast or a boot to keep the ankle from moving so that the bones can heal together.
Displaced and compound fractures with multiple broken bones and torn ligaments may require a surgical procedure.
The most common surgical procedure to repair a displaced open fracture is an open reduction with internal fixation. To begin, the surgeon will make an incision over the fracture area. The surgeon will open up the space to feel the pieces of bone and line them back up with each other. A plate and screws will be used to keep them aligned. Additional screws may be inserted through another incision to hold other fracture fragments in place.
If the ligaments holding the tibia and fibula are severely damaged, the surgeon will place a screw through both bones, or a suture device may be set through both bones. Both devices will help hold the bones together while the ligaments heal. At the end of the procedure, the surgeon will close any skin incisions with stitches.

Why Physiotherapy After Surgery Is Needed?

It’s easy for patients to assume that undergoing ankle surgery is the last step in the recovery process. However, doing so is a mistake that can permanently affect the health of your ankle. Physical therapy will be needed after your surgery to complete the healing process. That is because complications can arrive post-surgery, which are more likely to be eliminated through this treatment. Examples of the types of issues physical therapy can help with include:

  • Regain mobility — After surgery, your joints and muscles will likely become stiff, reducing your range of motion. This can make everyday tasks difficult. Patients will significantly improve their mobility by following a physical therapy recovery plan.

  • Support healing — By performing essential exercises, you will be able to improve circulation and enhance healing. Not only will you enhance the delivery of key nutrients to the site of injury, but also remove the build-up of fluids.

  • Reduces your reliance on medications — Last year, the Physiotherapy Association of B.C. stated that they could help alleviate the opioid crisis through the implementation of physical therapy. Many immediately opt for a drug plan, without considering the positive impact of physical therapy.

  • Improve balance — By strengthening your muscles and joints, you can prevent a fall due to improved balance. Physical therapy is a proactive solution against a possible injury in the future.

Ankle Fractures

Exercise after Ankle Webber A Fractures

  • Place a towel around your foot and pull the towel so your foot moves or is put toward you. Feel the stretch on the back of your calf. Hold this position for 20 seconds.
  • Keeping your lower leg still, turn your feet inwards to face each other and then outwards away from each other.
  • Move your uncle in a circular motion.
  • With your leg straight out in front of you, tighten your thigh muscle, so your knee straightens. You should see your kneecap move upwards if you pull the power correctly. Hold the contraction for five seconds, then relax.
  • Place a rolled-up towel under your knee. Tighten your thigh and lift your heel off the floor to straighten your knee. Make sure you keep the back of your knee against the towel. Hold this position for five seconds, then relax.
  • Pull your toes up toward you and tighten your thigh muscle. Lift your whole leg off the bed 10 centimetres and hold this position for 5 seconds. Slowly lower down.
  • Place a towel around your foot and pull the towel so your foot moves or is put toward you. Feel the stretch on the back of your calf. Hold this position for 20 seconds.
  • Keeping your lower leg still, turn your feet inwards to face each other and then outwards away from each other.
  • Move your uncle in a circular motion.
  • With your leg straight out in front of you, tighten your thigh, so your knee straightens; you should see your kneecap move upwards if you pull the muscle correctly. Hold the contraction for five seconds, then relax.
  • Place a rolled-up towel under your knee. Tighten your thigh and lift your heel off the floor to straighten your knee. Make sure you keep the back of your knee against the towel. Hold this position for five seconds, then relax.
  • Pull your toes toward you and tighten your thigh muscle; lift your whole leg off the bed 10 centimetres and hold this position for 5 seconds; slowly lower down.

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