ANKLE FRACTURES AND FRACTURE-DISLOCATION.

1. ANKLE FRACTURES AND FRACTURE-DISLOCATION. • Fractures and fracture-dislocation of the ankle are common. • Mechanisms ; twisting slipping. • The injury may be caused by direct trauma.

2. CLASSIFICATION. • Fractures of the ankle can be classified according to ; • Mechanism of injury. The Lauge-Hansen classification. This classification is very complex. • Anatomical . The relation of the fracture of the fibula to the syndesmosis ; Weber A , Weber B and Weber C.

3. CLINICAL FEATURES. • History of twisting the ankle. • Clinically the ankle is swollen, deformed ( if there is fracture-dislocation), and tender. • Identify areas of tenderness because they are a clue to the diagnosis and treatment. • Commonly closed injuries.

4. INVESTIGATIONS. • A fracture-dislocation of an ankle is a clinical diagnosis. The dislocation must be reduced and the ankle immobilized before sending patient to X-rays. • You must request three X-rays ; AP, LATERAL AND OBLIQUE. Each X-ray film must include the ankle and knee joints.

5. PRINCIPLES OF TREATMENT. • Reduce fracture-dislocations urgently. • Always splint the ankle. • Elevate the ankle to decrease swelling. • We operate all ankle fractures except those with a minimally displaced lateral malleolus with no medial tenderness. • Fracture of an ankle unites in six weeks.

6. COMPLICATIONS. • EARLY ; • Skin breakdown esp. In fracture-dislocation. • Vascular damage. • Swelling plus blisters.

7. COMPLICATIONS …….. • Late ; • Malunion. • Non-union. • Joint stiffness. • Osteo-arthritis. • Complex regional pain syndrome. • THE END.