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The first 25 slides, exactly as they appear. The full deck has 134 content slides.
Orthopaedics
Ankle Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
14 sections · 134 slides
Overview
- What this deck will teach you
Basic Theory and Concepts
The anatomy and biomechanics that make the talus fit its socket
- How common — and the load they carry
- Overview: why alignment is everything
Applied Anatomy
Bones, ligaments, the three columns, motion and the stabilising ring
- The bony socket: the ankle mortise
- The fibula and the talus: an offset, load-sharing pair
- Pathological anatomy: why millimetres matter
- Bony architecture of the ankle mortise and talus
- How fibular alignment governs talar position
- The medial (deltoid) ligament
- Deltoid rupture vs medial malleolus fracture
- The lateral collateral ligaments
- The distal tibiofibular (syndesmotic) ligament complex
- The three-column concept of the ankle
- Named avulsion fragments: where ligaments tear off bone
- Medial and lateral ligaments of the ankle
- Deltoid ligament behaviour by fragment size
- The axis and range of ankle motion
- Tilt of the ankle motion axis
- What stops the ankle at the ends of its range
- What limits dorsiflexion and plantar flexion
- Transverse (side-to-side) stability of the ankle
- Mechanisms of transverse ankle stability
- The stable ring of Neer — and how it breaks
- The stable annular structure of the ankle
- Movements of the foot and ankle, defined
- Motion axes of the tibiotalar and subtalar joints
- Motion axes of the transverse tarsal joint
Mechanisms of Injury
Lauge-Hansen: the foot's position plus the direction of force writes the fracture
- Direct vs indirect force, and the Lauge-Hansen rule
- Foot position determines which side fails first
- Supination-adduction injury (two stages)
- Supination-eversion injury (four phases)
- Mechanism of supination-eversion injury
- Pronation-abduction injury (three stages)
- Mechanism of pronation-abduction injury
- Pronation-external rotation injury (four phases)
- Mechanism of pronation-external rotation injury
Classification of Ankle Fractures
Lauge-Hansen, the AO/Weber system, and the eponymous fractures
- Two classifications, two purposes
- AO Type A — fibula fracture below the syndesmosis
- AO classification — Type A (below the syndesmosis)
- AO Type B — fibula fracture at the syndesmosis
- AO classification — Type B (across the syndesmosis)
- AO Type C — fibula fracture above the syndesmosis
- AO classification — Type C (above the syndesmosis)
- Eponymous fractures worth knowing (1)
- Eponymous fractures worth knowing (2)
- Eponymous ankle fractures
Assessment
Clinical examination, soft-tissue judgement and the radiographic checklist
- Clinical assessment: examine the skin too
- Soft-tissue injury that delays surgery
- Imaging: X-ray rules and the AP view
- The mortise view and its key measurements
- Mortise-view measurements and the dime sign
- Lateral and stress views, and CT
- CT showing syndesmotic widening
- Deciding stability: the surgical dividing line
Surgical Treatment
Indications, timing, approaches and step-by-step fixation of every malleolus
- When conservative treatment is enough
- When surgery is indicated
- The purposes of surgery, in order
- Timing: race the swelling, or wait it out
- Holding talar position with a posterior break
Approaches and Preparation
Choosing incisions and positioning to protect nerves and skin
- Lateral vs medial surgical approach
- Positioning and preparation
- Patient positioning for ankle fracture surgery
- The lateral incision: planning and nerves at risk
- Planning the lateral malleolus incision
- The lateral approach: protect the blood supply
- The lateral approach: superficial and deep dissection
- Exposing the Volkmann (posterior) fragment
- Limited and broadened exposure of the Volkmann fragment
- The medial incision and approach
- Medial malleolus incision
- Exposing the medial malleolus fracture ends
Reduction and Fixation of the Fibula
Matching the implant to the AO type — tension band, anti-glide, neutralization and bridging
- Fibula first: the general principle
- Tension band plate fixation (type A)
- Tension band plate fixation of the fibula
- Kirschner wire tension band (small fragment)
- Kirschner wire and steel-wire tension band fixation
- Type B fibula: anti-glide plating
- Anti-glide plate fixation of the fibula
- Lag screw plus neutralization plate
- Lag screw and coaxial-sleeve drilling technique
- Lag screw and neutralization plate — type B3.2 case
- Bridging plate for comminuted fibula
- Bridging plate for a comminuted fibula
- Type C fibula: restore length, then fix the syndesmosis
- Type C3.2 fibula: a malreduction lesson
- Fixing the Wagstaffe and Tillaux-Chaput fragments
- Fixation of the Tillaux-Chaput fragment
Fixing the Medial Malleolus
Avulsion screws, the 'open-book' reduction and buttressing the split
- Medial malleolus avulsion: cannulated lag screws
- Cannulated lag screws for a medial avulsion
- Vertical split fracture: the 'open-book' reduction
- The 'open-book' reduction of a split medial malleolus
- High split: support screws or buttress plate
- How to handle the deltoid ligament
The Posterior Malleolus
The Volkmann fragment: indirect reduction and anterior-to-posterior lag screws
- Fixing the posterior malleolus fragment
- Anterior-to-posterior fixation of the Volkmann fragment
- Buttress plating of a high Volkmann fragment
Fixation of the Syndesmosis
Testing stability, reducing the joint, and placing the positioning screw correctly
- Testing whether the syndesmosis is stable
- Hook test for syndesmotic stability
- Reducing the syndesmosis before fixing it
- The syndesmotic screw: number, size and position
- The syndesmotic screw: angle, depth and removal
- Placing the syndesmotic positioning screw
- Bosworth fracture: open reduction and fixation
- Type C1.1 fracture with syndesmotic screw breakage
Postoperative Management and Lessons
Immobilisation, weight-bearing rules and the 'fibula priority' principle
- Postoperative management
- Lessons: fibula priority and its exceptions
Complications
Malunion, malreduction, traumatic arthritis and infection
- Malunion of the fibula
- Malreduction of the medial malleolus and syndesmosis
- Syndesmotic malreduction and its revision (1)
- Syndesmotic malreduction and its revision (2)
- Traumatic arthritis and infection
- Postoperative wound infection after plating
- Key takeaways
- References (1/6)
- References (2/6)
- References (3/6)
- References (4/6)
- References (5/6)
- References (6/6)
- Orthopaedic Trauma Surgery — Volume 2: Lower Extremity