1 / 35

Sequalae of Ankle Sprains: Peri Articular Fractures of the Ankle in Sports Medicine

Sequalae of Ankle Sprains: Peri Articular Fractures of the Ankle in Sports Medicine . A. Amendola MD Professor , Dept of Orthopaedic Surgery Director , Sports Medicine Center University of Iowa . Chronic Ankle Pain . The most common cause of chronic pain following

liam
Télécharger la présentation

Sequalae of Ankle Sprains: Peri Articular Fractures of the Ankle in Sports Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sequalae of Ankle Sprains:Peri Articular Fractures of the Ankle in Sports Medicine A. Amendola MD Professor , Dept of Orthopaedic Surgery Director , Sports Medicine Center University of Iowa

  2. Chronic Ankle Pain • The most common cause of chronic pain following an ankle sprain is a missed or associated injury From Alexander, Foot and Ankle Examination

  3. Extra-articular Bone ( avulsions ) Soft tissue Neural Venous stasis Intra-articular OLT / tibia Impingement OA / chondromalacia Synovitis Chronic Ankle Pain Differential Diagnosis

  4. medial malleollus Lateral malleolus Posterior malleollus Talus Posteromedial ( Cedell #) Posterior ( os trigonum ) Lateral wall Anterior process calcaneus Bone Injuries ( peri –articular avulsions ) Differential Diagnosis

  5. Approach Detailed clinical exam Correlate symptoms with exam and imaging Most of these injuries are palpable ( tenderness ) Operative approach : open vs arthroscopic Chronic Ankle Pain

  6. Ankle pain ; history of recurrent sprains

  7. Ankle pain ; recurrent sprains Anterior impingement and medial malleollar avulsion

  8. Lateral malleollar avulsions • Usually associated with avulsion of CFL • Usually not signifcant and CFL scars in or can be repaired to remaining fibula • Rx if symptomatic • Excise if stable , pain only (arthroscopic) • Excise if unstable , repair CFL to fibula ( open )( video )

  9. Lateral Ligaments : fibular avulsion ( CFL ) Leg ATF Foot ATF CFL CFL

  10. Lateral malleollar avulsions

  11. Calcaneus : Anterior process avulsion fracture • Pain post sprain • Easily missed on X-rays • High index of suspicion • Scrutinize X-rays • Bone tenderness always present • Rx : Open excision if problematic

  12. Talus Fractures • Osteochondral • Shear / sagittal / coronal • Posterior process • Os trigonum • Posteromedial ( Cedell ) / posterolateral process • Lateral process

  13. Video Os trigonum fracture , 17yoM

  14. Lateral Talar process fx • “Snowboarder’s fracture ” • Diagnosis delayed & associated with ankle sprains • Need a high degree of suspicion

  15. Treatment : lateral process # • Acute - nondisplaced: cast treatment NWB • Acute - displaced: ORIF or excise • Late: excise or ORIF based on size ( usually chronic subfibular pain ) • Excise open or arthroscopic

  16. Lateral talar process avulsion • Rx : excision

  17. Excision lat talar process : chronic

  18. Post Talar Body fracture

  19. Post talar body fracture ( video )

  20. Post talar body fracture fixationARIF ( video )

  21. Periarticular ( avulsion ) Fractures Sports Trauma Summary: • Common cause of Chronic dysfunction / pain • Ankle arthroscopy is an excellent procedure for evaluation and treatment • minimal morbidity with careful technique • Excision is the common treatment , unless fixation warranted

  22. Ankle Arthroscopy Acute AnkleFractures: • Advantages • avoids extensive exposure • improves visualization of articular surface • maintains existing blood supply Disadvantages • time consuming • technically more challenging • swelling of soft tissues

  23. Ankle Arthroscopy Acute AnkleFractures: • Indications • Mild to moderate pilon fractures/ impaction • To ensure articular surface reduction • Remove loose fragments/ hematoma/ chondral injury

  24. 50 yo M , impacted pilon #

  25. Post op 1 year post op

  26. Case : fibular # ;medial dome talus

  27. Case :; fibular # ;medial dome talus

  28. Case : fibular # ;medial dome talus

  29. Case : fibular # ;medial dome talus

  30. Literature Review • Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A. • Bone Joint Surg Br. 2000 Apr;82(3):345-51. • Arthroscopic findings in acute fractures of the ankle. • Prospective study • Ankle # in 288 consecutive patients (148 men and 140 women) • AO-Danis-Weber , 14 type-A,198 type B and 76 type C. • Chondral lesions in 228 ankles (79.2%), the talus (69.4%) ;distal tibia (45.8%), the fibula (45.1%), medial malleolus (41.3%). • worse in patients under 30 years and in those over 60 years of age. • The frequency and severity of the lesions increased from type-B to type-C fractures (p < 0.05).

  31. Literature Review : ARIF Ankle # • Ono A, Nishikawa S, Nagao A, Irie T, Sasaki M, Kouno T. • Arthroscopy. 2004 Jul;20(6):627-31. • Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. • 105 patients (105 joints) ; malleolar fractures • Cartilaginous damage was noted in 21 patients • distal tibiofibular joint diastasis + fixation in 8 patients. • good result in 100 cases and a fair outcome in 5 • (no control group).

  32. Use of Ankle Arthroscopy with Fractures Summary • Useful adjunct in diagnosis and treatment • Biologic exposure • Needs further experience and investigation

More Related