Undisplaced and minimally displaced isolated lateral malleolar fractures weber b usually unite without operative intervention. Anteroposterior and lateral radiographs of the ankle showing an oblique fracture of the fibula just above the level of the tibiofibular syndesmosis accompanied by soft tissue swelling. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. The medial malleolus osteoligamentous complex and its role. Intrmedullary versus extramedullary fixation of lateral. Numerical simulation of the posterior malleolus fracture with. This case demonstrates why a knowledge of common anatomical variants is essential the small bony chips lateral to the tip of the lateral malleolus represent an avulsion fracture while the wellcorticated bony fragment adjacent to the medial aspect of the lateral malleolus tip could be mistaken for fracture if this was not the typical appearance and location for an accessory. The bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural. But a medial malleolus fracture is more often part of a compound injury involving one or both of the other ankle parts. May 08, 2017 a medial malleolus fracture is a crack or break in the medial malleolus plural form. Posterior malleolar fractures of the ankle article pdf available in european journal of trauma and emergency surgery 416 august 2015 with 5,710 reads how we measure reads. There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. A medial malleolus fracture is a break in the tibia, at the inside of the lower leg.
This information will guide you through the next 6 weeks of your rehabilitation. A medial malleolus fracture is a condition characterized by a break in the bony process situated at the inner aspect of the ankle known as the medial malleolus figure 1. The first decision is indirect versus direct approach for the posterior malleolar fracture. Is it possible to walk on a medial malleolus fracture. This usually occurs in association with a traumatic force such as a rolled ankle or a direct blow and causes a sudden onset of intense pain in the area. Weight bearing on the injured ankle may be advised to be avoided and it should be protected while it is healing. An ankle fracture is a break of one or more ankle bones. The medial malleolus is implicated in an eversion position and an abduction force, stressing the deltoid ligament complex and potentially leading to a medial malleolus avulsion fracture. Ankle undisplaced medial malleolus fracture virtual. A fracture is an interruption of the continuity of bone, this page will discuss ankle and foot fractures and the role that physiotherapists play in the rehabiliation of such injuries. The mason and molloy classification of posterior malleolus fractures based on computed tomography ct scan findings showed that in type 2 fracture patterns haraguchi types 1 and 2, only 49% had. Syndesmosis or medial malleolar injury not evident in this patient. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or.
Complications may include an associated high ankle sprain, compartment syndrome, decreased range of motion, and malunion. Jan 20, 2016 the laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Pdf ankle fracture is one of the most common lower limb fractures for they. Type 6 is an open fracture in which part of the physis is missing. Management of the posterior malleolus in trimalleolar.
As your ankle was pushed over by the horse, the ligament pulled a piece off the tip but it remained in place so should heal well. Ankle fractures are among the most common fractures in adults, and the medial malleolus is often involved. The xrays came back saying an oblique fracture through the distal fibula at the level of the ankle mortis. A lateral malleolus muhleeuhlus fracture is a type of broken ankle that happens when part of the fibula just above the ankle joint fractures more to know.
Symptoms fractures are acute injuries occur suddenly therefore symptoms can often be noticed immediately following injury. Uni malleolar fractures are the most common 68%, followed by bi malleolar fractures 25% and tri malleolar fractures 7%. The surgery is often so predictable that the surgeon may go into auto pilot mode more appropriately termed. Since coopers description of the trimalleolar fracture in 1822, several publications have discussed and analyzed the challenges and pitfalls of posterior malleolar fractures 47. The fracture may be treated with a short leg cast or a removable brace. Metatarsal shaft fractures are initially treated with a posterior splint and. The reason is that nonsurgical treatment has been shown to be just as effective for the treatment of the broken bone. A stress x ray of the ankle may be needed under general anaesthetic to demonstrate the disruption of the syndesmosis. Jun, 2014 ankle fracture surgery video dr moore using stryker variax fibula plating system duration. The medial malleolus osteoligamentous complex and its role in. A stress fracture of the medial malleolus usually occurs in long distance runners, but also high demand athletic individuals like jumpers and gymnastics 7,22. When the foot rolls inwards, this causes a compression of the medial malleolus on the inner side of the ankle. Pdf pathoanatomy and associated injuries of posterior. Bimalleolar fractures and trimalleolar fractures as seen with xray.
Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Fractures of the ankle joint are common amongst adults. Tenderness of the medial malleolus may mean a rupture of the deltoid ligament, even if the x rays appear normal. The code is valid for the year 2020 for the submission of hipaacovered transactions. Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults. Pdf on aug 1, 2018, tom carter and others published ankle fractures. The verticallyoriented medial malleolus fracture supinationadductioninjuries,startsatthebendofthetibia andextendsinasuperiordirection. Adult ankle fractures ankle and foot soft tissue injuries. It would usually take around 6 weeks for the ankle to heal 4, 6. Lateral malleolus avulsion fracture with os subfibulare. Most fractures are associated with ligament injuries, and the magnitude and direction of the deforming force applied to the ankle joints directly co rrelate to the fracture pattern 8. Children remodel avhap educational talk 28 june 2011, duy thai. Ankle fracture is one of the most common lower limb fractures for they. Sprouse, md, west virginia university school of medicine.
The journal of diabetic foot complications open access. Diagnosis and management of common foot fractures david bica, do, brown university alpert medical school, pawtucket, rhode island ryan a. The laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Plaster immobilisation of a stable fracture leads to secondary bone healing with fracture callous 5. To date, fixation of posterior malleolar fractures has. Symptoms may include pain, swelling, bruising, and an inability to walk on the leg. Management of distal tibial medial malleolus type6. Fracture of the lateral malleolus is also occurred when the ankle is either twisted or rolled, usually with an awkward or uneven step. A substantial part of all ankle fractures 744% involve the posterior malleolus 3. Aug 14, 2019 an isolated fracture of the medial malleolus generally occurs when the foot is forcefully rolled inwards or outwards.
A lateral malleolus muhleeuhlus fracture is a type of broken ankle that happens when part of the fibula just above the ankle joint fractures. It may also involve injury to a ligament of the leg. Usually, you need to avoid putting weight on your leg for approximately 6 weeks. Once a direct approach is chosen, the type is decided based on the fracture locations. Radiographic analysis of adult ankle fractures using combined. Malleolus definition of malleolus by medical dictionary. Simison department of orthopaedic surgery, arrowe park hospital, wirral, and university department of orthopaedic surgery, royal liverpool university hospital, liverpool, uk injury, 1994, vol. Facts and fiction find, read and cite all the research you need on. The main concern is whether there is a broken bone. This bone is part of the fibula, one of two bones of the leg. May 23, 2014 fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. Nondisplaced fracture of lateral malleolus of left fibula, subsequent encounter for closed fracture with delayed healing. The code is exempt from present on admission poa reporting for inpatient admissions to general. When the foot rolls out, this pulls tension on the medial malleolus, which can also cause a fracture.
Posterior malleolar fractures, fibular fractures above the inferior tibiofibular. A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. This type of fracture is typically seen with patients who have had rotational forces acted on the leg or after landing from a forceful and impactful jump. Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral malleolus following a. Management of distal tibial medial malleolus type6 physeal. The lateral malleolus is the name given to the bone on the outside of the ankle joint. Fractures can occur at different levels of the medial malleolus. Management is determined by the location of the fracture and its effect on balance and weight bearing. Fracture of the lateral malleolus twin boro physical therapy. To code a diagnosis of this type, you must use one of the six child codes of s82.
In the clinical arm of the study, 42 patients with bimalleolar ankle fractures and 11 patients with a lateral malleolus fracture and tear of the deltoid ligament indicated by talar shift were treated operatively. Disp fx of lateral end of left clavicle, init for opn fx. Collicular fractures of the medial malleolus sciencedirect. Operative fixation of medial malleolar fractures, whether isolated or in the setting of bi or. Most commonly, surgeons use two screws to fixate the fracture and it is a short procedure in terms of operative time. Radiographs and computed tomograms are main diagnostic aids. The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade.
Spiral fracture of the proximal third of the fibula with an associated fracture of the medial malleolus or rupture of the deep deltoid ligament per4 fracture palpation along the entire length of the fibular is important in order to pick up signs of this injury as it can be. A lateral malleolus fracture is an injury involving a complete break in the boney prominence located at the outer aspect of the ankle i. Medial malleolus fracture fractured medial malleolus. Fractures commonly happen because of car accidents, falls, or sports.
Ankle fracture surgery video dr moore using stryker variax fibula plating system duration. Medial malleolus fracture symptoms, treatment, causes. Ankle fractures are among the most common type of fractures in the lower extremity. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. Open left clavicle acromial end collar bone fracture icd10cm diagnosis code s42. The authors present a case report involving an isolated nondisplaced medial malleolus fracture in a diabetic patient, the sequelae into acute charcot arthropathy, and treatment recommendations. You will need to see your physician regularly for repeat xrays to make sure the fracture does not change in position. The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood now. How does it work when we combine the weber classification to the stages of. Nonunion of distal fractures of the fibula type weber b is rare. Frequently it is difficult to distinguish a fracture broken bone over a sprain, dislocation, or tendon injury without xrays of the ankle.
A surgery may not be required if the ankle is still stable and no bone has been displaced. Always examine the ankle when you see a spiral fracture of the fibular neck. Weber b fracture of the lateral malleolus with concomitant. Studies have shown 3 that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities. Lateral malleolus fracture healing time, treatment, icd 9. Pre and postop medial malleolus fracture with screw fixation. The clear answer is that surgery is a worse option for stable lateral malleolus fractures. Medial malleolus fracture and lateral malleolus fractures xray appearances. Fracture of the tip of the lateral malleolus bunnie, you have an undisplaced fracture of the tip of the malleolus. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. The distal ridge of the lateral malleolus was removed with an osteotome and a 2.
Malleolar fractures include injuries of bones malleoli and or ligaments. Oct 26, 2017 but a medial malleolus fracture is more often part of a compound injury involving one or both of the other ankle parts. Pre and postop xrays of orif medial malleolus fracture. It is the least common physeal fracture, but has the highest rate of complications, particularly the formation of a physeal bar. Stress fractures of the medial malleolus and distal fibula. These fractures are more common in women nearly 60 percent than men. Trauma xray lower limb gallery 2 ankle malleolar fractures. A 23 cm longitudinal incision was made over the distal fibula. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities a trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect. Nov 28, 2019 jonathan cluett, md, is a boardcertified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Medial malleolus fracture and broken ankle treatment. Feb 28, 2008 type 6 is an open fracture in which part of the physis is missing. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or with an injury to the ankle ligaments. On xrays, there can be a fracture of the medial malleolus, the lateral malleolus, or.
It was designed to mimic the contours of the lateral malleolus and its medullary canal. Spiral fracture of the proximal third of the fibula with an associated fracture of the medial malleolus or rupture of the deep deltoid ligament per4 fracture palpation along the entire length of the fibular is important in order to pick up signs of this injury as it can be seen in patients with relatively unremarkable ankle xrays. With initial conservative management till swelling subsides,open reduction and adequate internal fixation. Again, if the force continues, the talus will shift laterally and impact the lateral malleolus, causing an oblique fracture. Basically there are three main types of ankle fractures. Those with experience in the surgical treatment of ankle fractures often consider the medial malleolus fracture a relatively straightforward fracture to repair. Softtissue injury is common as the bones are subcutaneous. The lower leg comprises of 2 long bones, known as the tibia and the fibula, which are situated beside each other figure 2. Lateral malleolus fracture healing time, treatment, icd. If the broken bone punctures the skin, it is called an open or compound fracture. Clinical union precedes radiological union by 4 6 weeks 6. Ankle malleolus fracture weber b lateral same patient as image above the lateral view shows a less obvious fracture line through the distal fibula partly obscured by the tibia. In addition, surgery has a chance of both infection and healing problems about 2 percent and these can cause significant problems. Joint anatomy and biomechanics the ankle joint is a hinge joint, the lower end of the tibia and its medial malleolus, together with the lateral mal.