12 Jun medial malleolus fracture classification radiology

The medial ankle injury may be either a visible medial malleolus fracture or an invisible injury of the medial ligaments. An isolated fracture of the medial malleolus, or widening of the ankle joint with no visible fracture seen on ankle X-ray, should raise the suspicion of an associated fracture of the fibula. Fracture of the fibula below the level of tibial plafond. The Tillaux fracture occurs in older children at the antero-lateral tibial epiphysis before complete fusion has occurred: Two main classification systems are used to group the various ankle fractures: the Weber and the Lauge-Hansen (LH) classification schema. Pronation- weight on medial foot. Isolated fracture of the medial malleolus According to Lauge-Hansen this is the first stage of a pronation exorotation injury, which results in a Weber C fracture. In the Lauge-Hansen classification this is an avulsion of the lateral malleolus (stage 1) as a result of the supination position of the foot and a push-off fracture of the medial malleolus (stage 2) as a result of an adduction force applied by the foot. Symptoms may include pain, swelling, bruising, and an inability to walk on the leg. Fractures (fxs) of distal tibia and fibula are divided into. It takes the Danis-Weber classification into account and can be correlated to the Lauge-Hansen classification. The proposed mechanism is avulsion at the talar attachment of the posterior tibiotalar ligament with the ankle in dorsiflexion and pronation ( 30 ). Deltoid ligament under stress in pronation. Note of caution: With ‘isolated’ medial malleolar or ‘isolated’ syndesmostic injuries, always examine the the proximal fibula to look for a Maisonneuve fractures (see classification section for further details). On the left image the lateral malleolus is pushed off by exorotation of the talus. No sign of an oblique fracture of the lateral malleolus, so we can exclude a Weber B fracture. Another possible indicator might be a vertical course of an associated medial … Radiographs demonstrating a fracture fragment posterior and medial to the talus are diagnostic of a Cedell posterior medial tubercle fracture. The peak age for injury is 11 to 12 years. These fractures often occur in sports involving a sudden change of direction. Symptoms of a medial malleolus fracture can include: Your doctor will diagnose your ankle by physical examination and manipulation of the ankle, possibly followed by X-rays. Posterior … Lauge-Hansen classification system describes the progression of injury around the ankle joint in a staged sequence. It is a break of the lateral malleolus, the knobby bump on the outside of the ankle (in the lower portion of the fibula). •Classification: Lauge-Hansen •Specific Problem Areas: Posterior Malleolus and Syndesmosis •Surgical Goals •Outcome . LCL tear avulsion fracture of lateral malleolus: Supination-external rotation. Results in fracture of lateral proximal fibula fracture … The clear medial space should be <4mm. Avulsion of the lateral malleolus; Oblique fracture of the medial malleolus (uncommon) Weber B = Transsyndesmotic. Jun 9, 2019 - The Radiology Assistant : Ankle fracture - Weber and Lauge-Hansen Classification. How important is this topic for board examinations? Lauge Hansen Classification of Ankle Fractures. Weber A fractures occur below the level of the tibial plafond. Salter-Harris I distal tibia fractures can be diagnosed if there is tenderness directly on the medial malleolus (rather than the ligaments) and many recommend treating as a … There is still the possibility of a Weber C fracture, i.e. Discussion. Surgery is the primary treatment of bimalleolar fracture because it is an unstable fracture. An ankle fracture is a break of one or more ankle bones. Example 1 Basic interpretation There is a medial malleolar fracture. Medial malleolus fractures usually occur in conjunction with lateral malleolus fractures but occasionally occur as an isolated injury in P-ER or P-AB injuries (see Figure 21-2). In Stage 2, either a vertical medial malleolus fracture or injury to the deltoid ligament occurred [ 12 ]. Equally, if ED refer a ‘isolated’ proximal fibula fracture, make sure to examine the patients ankle for a medial sided injury (this may be bony or ligamentous). At reexamination you notice the subtle avulsion of the medial malleolus red arrowwhich is stage 1. This image shows additional fracture of the posterior malleolus, making … Talofibular sprain or distal fibular avulsion ... smoking, decreased education, alcohol use, presence of medial malleolar fracture. Weber A fractures occur below the level of the tibial plafond. Maisonneuve: either a medial malleolus fracture or deltoid ligament tear with a high fibular fracture. T/F? Dictated by the Salter Harris Classification of Physeal Fractures . 1. On the medial side of the ankle, an eversion force first sprains the deltoid ligament or avulses the distal medial malleolus ( Figure 13-6 ).As the eversion force continues, an impaction (oblique) fracture of the lateral malleolus may occur or the syndesmosis may be ruptured ( Figure 13-7 ).External rotation combined with eversion of the ankle may result in a proximal fibula fracture, the so … (a) Frontal radiograph shows the site of pain (arrowhead), a medial malleolar fracture (white arrow), and a spiral fracture of the distal fibula (black arrow) about 9 cm above the plafond. Weber classification of distal fibular fractures (courtesy of faculty.washington.edu) In order to discuss treatment of these fractures, it is important to understand the anatomy of the ankle … 2. Medial malleolus injuries to the ankle result from eversion forces. This activity reviews the evaluation and management of bimalleolar fractures and studies the … How important is this topic for board examinations? Patella baja: rupture of the quadriceps tendon. The posterior malleolus fracture is best appreciated on the lateral radiograph of the ankle, evident as a bony discontinuity often associated with an articular step-off. … There is also the anterior … Differential diagnosis Patella fractures/dislocations Patella alta: rupture of the infrapatellar tendon. When these ankle injury types are seen without a fracture of the lateral malleolus, further imaging of the entire fibula is recommended. ORIF superior to closed treatment of bimalleolar fractures. A transverse or horizontal fracture is the result of a 'pull-off'. (The third malleolus is the posterior margin of the distal tibia.) Full size image. Inclusion criteria were isolated distal fibular fracture, fracture line within 6 cm of the tip of the lateral malleolus, medial clear space ≤ 5 mm on a nonstressed mortise radiograph, and medial clear space ≥ 5 mm on a stressed radiograph (Figs. Plain radiograph Ankle views may show a fracture of the medial malleolus or widening of the medial ankle joint space due to deltoid ligament injury, as well as widening of the distal tibiofibular syndesmosis. (The third malleolus is the posterior margin of the distal tibia.) On the mortise view, there should be symmetrical joint space around the talus. Most of the changes took place in AO 44 type C followed by types B and A. 2. Evaluation: Clinical HISTORY Mechanism Timing Soft-tissue injury Bone quality Comorbidities Associated Injuries PHYSICAL EXAM Skin Nerves Vasculature Pain Deformity . Type I and II Fractures: Often Amenable to Closed Tx / Lower Risk of Physeal Arrest Type III and IV: More Likely to Require Operative Tx / Higher Risk of Physeal Arrest ... – 42 Pediatric Medial Malleolus Fractures with > 3 Months Follow-Up – 52% Developed a Physeal Bar – 27% of These were Diagnosed > 6 Months from Injury – SH … PEARL. There are three classifications based on the location and type of fracture. ... Isolated medial malleolus fracture can be treated by non-operative means [short leg walking cast or cast boot] in following situations. Radiology. The classification of malleolar fractures constitutes the basis for treatment of acute ankle fractures. Types include lateral malleolus, … Example 1 Basic interpretation There is a medial malleolar fracture. Summary. May be associated with oblique or vertical medial malleolus fracture. The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate. LCL tear avulsion fracture of lateral malleolus: Supination-external rotation. Image 1. ... Isolated medial malleolus fracture can be treated by non-operative means [short leg walking cast or cast boot] in following situations. There are various types of ankle fractures and the degree of severity of the injury varies, according to the specific characteristics of each fracture.… Ankle Fracture: Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. high incidence of post-traumatic arthritis. There is still the possibility of a Weber C fracture stage 4, i. Blow out Fracture . An oblique or vertically oriented fracture indicates 'push-off'. Here, we study the fracture pattern, mechanisms, and recommendations for … Enormous forces must have pushed off the medial malleolus. So we have to look for higher stages. An external rotation stress radiograph or … McGovern Medical School XR R Ankle. Classification of posterior malleolar ... a double contour of the medial malleolus if the PM fracture involves the medial malleolus [35]). McGovern Medical School XR R Ankle •3 mm cortical offset at … Pilon fx: tibial plafond fx due to axial load. Lauge-Hansen Classification. There is also the anterior … Classification of ankle fractures . Medial malleolus fracture. 1 at postoperative 2 years indicating that the fracture had healed and ankle joint function had restored. A bimalleolar fracture is a fracture of the lateral malleolus and the medial malleolus. (b) Mortise radiograph shows the site of pain (arrowhead), the fibular fracture (black arrow), and widening of the tibiofibular space (white arrow). In a typical Maisonneuve injury, the involved structures caused by the PER IV mechanism include the fracture of the medial malleolus (or the rupture of the deltoid ligament), rupture of the AITFL (or avulsion fracture of the insertion), rupture of the IOL, rupture of the IOM, fracture of the proximal fibula, and rupture of the PITFL (or avulsion fracture of the insertion). Supination-Adduction Injury. The injury starts on the medial side with either a rupture of the medial collateral ligaments or an avulsion of the medial malleolus. Isolated fracture of the medial malleolus According to Lauge-Hansen this is the first stage of a pronation exorotation injury, which results in a Weber C fracture. • describe principles of malleolar fracture classification • outline indications for nonoperative and surgical treatment • discuss principles of malleolar fracture fixation Malleolar fractures Malleolar fractures include injuries of bones (malleoli) and or ligaments. When these ankle injury types are seen without a fracture of the lateral malleolus, further imaging of the entire fibula is recommended. There is a fibrous pulley enthesis on the posterior aspect of the medial malleolus where the TPT passes around it. Fig. It is based on the fibular fracture in relation to the syndesmosis on radiography (this refers to the syndesmosis between tibia and fibula): Type A: fibular fracture below the syndesmosis, … It takes the Danis-Weber classification into account and can be correlated to the Lauge-Hansen classification. There is also the anterior … open fracture/open joint injury. Pilon fx: tibial plafond fx due to axial load. Stress Fractures. An oblique or vertically oriented fracture indicates 'push-off'. The AO/OTA classification of malleolar segment fractures is one of the most frequently used systems for classifying malleolar fractures. The aim of this study was to describe the epidemiology of ankle fractures treated at Sahlgrenska University Hospital (SU) during a 2-year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar fractures at … You step wrong and twist your foot inward or outward to … ORIF superior to closed treatment of bimalleolar fractures. compound fracture). trimalleolar (medial, posterior, lateral) fractures. Lower Extremity. Trimalleolar fractures refer to a three-part fracture of the ankle. Fracture of the medial malleolus associated with a transverse supramalleolar (2 cm or higher above the joint line) fibula fracture. ... one utilizes an osteotomy of the medial malleolus. The other two are the lateral and the posterior malleolus. Weber classification: ... An isolated fracture of the medial malleolus associated with a widening of the medial joint space. A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. Note that instead of a malleolar fracture, the corresponding medial (deltoid) or lateral collateral ligament may be torn. Syndesmotic disruption is rare but can occur. 23.2). 27.6 ). Blow-out fractures are produced by a traumatic force. Syndesmotic disruption is rare but can occur. The cause may include excessive stress on the joint such as from rolling an ankle or blunt trauma. 2. Stage II: AITFL syndesmotic rupture or avulsion of its insertion. Maximum change was noted in trimalleolar fractures followed by bimalleolar and unimalleolar. Patella fractures/dislocations Patella alta: rupture of the infrapatellar tendon. This fracture is a bimodal distribution, most likely affects older women and young males and more than 60 years old. They are most often caused by twisting the ankle, the circumstances of which the patient will typically recall. Radiology Guides Anatomy Physio & Path Medicine Physics Contact ☰ ... 80% is central. Medial malleolus injuries to the ankle result from eversion forces. Trimalleolar fractures refer to a three-part fracture of the ankle. Depending on the direction and … Lateral malleolar soft tissue swelling. There is still the possibility of a Weber C fracture, i.e. This results in structural fatigue of the bone, causing pain, performance impairment and potentially a complete fracture. Usually an avulsion injury from supination of foot. There are three main types of Weber fractures (A,B, and C). Most commonly associated with pronation external rotation injuries. May secondarily involve malleoli. Bi-malleolar Equivalent: A fracture of the lateral malleolus can be associated with an injury to the deltoid ligament (which connects the talus and distal tibia and supports the medial aspect of the ankle joint) without a fracture of the medial malleolus … Malleolus fx: due to shear or twisting forces. medial rupture or avulsion, high fibular fracture and finally a posterior malleolar fracture. There is an avulsion fracture of the medial malleolus and a fibula fracture above the level of the … The break may occur by itself but it normally accompanies injuries to the outside of the ankle or a fibula fracture of the smaller of the two lower leg bones. Usually an avulsion injury from supination of foot. (A) Initial radiograph of the left ankle shows a fracture was a faint vertical sclerotic line in the medial malleolus of the ankle joint. There are various ways of classifying ankle fractures. The major symptoms are pain in the affected area and decreased range of motion.If physical examination and the patient history suggest a fracture (e.g., patient is unable to bear weight on the affected leg), an x … Epiphyseal plate injury should be suspected in any child with injuries to joints, be it fracture, dislocation, ligamentous rupture or even simple sprains. On this basis, we concluded … It is supported by ligaments to stabilize the talus under the tibia and the tibia with the fibula. Complications may include an associated high ankle sprain, compartment syndrome, decreased range of motion, and malunion.. This fracture is a bimodal distribution, most likely affects older women and young males and more than 60 years old. Three frequently used methods to describe ankle fractures are ... of the medial malleolus and was measured 0.5 cm beneath the talar dome, on a line parallel to the … The injury can continue to the following: stage 2: rupture of the anterior syndesmosis ; stage 3: high fibular fracture Usually stable: but sometimes in need of an open reduction and internal fixation (ORIF) especially if the medial malleolus is fractured. Evaluation: Radiographic Anteroposterior View – Tibiofibular overlap ~ 10mm – Tibiofibular clear … 11. Surgery on the medial malleoli can improve the chances of successful healing and allow the person to resume normal movement sooner. The Radiology Assistant : Ankle fracture – Weber and Lauge-Hansen Classification. Radiographic findings of obvious ankle instability may include significant fracture displacement, subluxation or dislocation of the talus under the plafond, and widening of the medial joint space. An isolated fracture of the medial malleolus, or widening of the ankle joint with no visible fracture seen on ankle X-ray, should raise the suspicion of an associated fracture of the fibula. 20). 11. Radiographs demonstrating a fracture fragment posterior and medial to the talus are diagnostic of a Cedell posterior medial tubercle fracture. 3. Stage 1 = disruption of anterior distal tibiofibular ligament Stage 2 = +distal fibular fracture Stage 3 = +tear of posterior distal tibiofibular ligament, fracture of posterior malleolus Stage 4 = +fracture of medial malleolus: Pronation Classification of Malleolar Fractures Lauge-Hansen Classification. Stress fractures represent the failure of the bony skeleton to absorb repetitive loads. The authors also proposed the effect each injury … … True: The distal tibiofibular joint is classified as what type of joint? (2006). The other criteria commonly used is the Lauge-Hansen classification. May be associated with oblique or vertical medial malleolus fracture. Some unstable fractures, are obvious on physical exam and radiology, but some can be indistinguishable from stable injuries on initial evaluation. Lateral malleolus fracture (Weber A) 2: Add vertical medial malleolus fracture: Pronation External rotation: Deltoid ligament under stress in pronation. Which of the following statements accurately describe this radiograph? Pull-off or Push-off fractures The shape of a fracture indicates which forces were involved. The ligaments at the lateral side of the ankle are exposed to high stress and an (horizontal) avulsion fracture develops (stage I). L6 – years in practice. An X-ray of the whole lower limb should be done to exclude a high fibula fracture. The medial malleolus fracture was fixed with two cannulated screws, and the lateral malleolus fracture was fixed with a Kirschner wire along the radial axis. A bimalleolar fracture is a fracture of the lateral malleolus and the medial malleolus. Whereas, in an os subtibiale both margins are usually smooth, … (A) Initial radiograph of the left ankle shows a fracture was a faint vertical sclerotic line in the medial malleolus of the ankle joint. A transverse or horizontal fracture is the result of a 'pull-off'. Branches from the dorsalis pedis supply the talar head and most of the dorsal talar neck. The Hannover classification assigns one point to each of a possible five fragments and one point to involvement of each of three articular surfaces (, 17). Lateral radiograph from a 27-year-old woman with a pronation external rotation–type ankle injury. This type of fracture and its classification system is named for Robert B. Salter and William H. Harris who created and published … All will have a fracture clinic follow up in a week or so. Although MRI showed an intact posterior malleolus, the posterior tibiofibular ligament was thickened and attached to a slip of avulsed tibial periosteum … Clinical Presentation. On the right image the medial malleolus is pulled off by the medial collateral ligament due to pronation of the foot. Factors affecting the prognosis of epiphyseal plate injuries include the mechanism of this, the age of the child at the time of injury, the blood supply to the epiphysis, the method of reduction and the extent of soft tissue injury (e.g. CT examination is very helpful whenever there is any question about … medial malleolus fracture or deltoid ligament injury often present fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture) unstable: usually requires ORIF Weber C fractures can be further subclassified as 6 This will lead to more decisions about further investigation and other forms of treatment. Today. Ankle fractures are a very common entity in musculoskeletal radiology (and for many a weekend warrior). Danis-weber classificationBased on location and appearance of the fibularfracture Type A fracture is caused by internal rotation andadduction. If the force is high enough, the medial malleolus can be “pushed away” as it were (= vertical fracture) by the rotating talus (stage II) (fig. On the left image the lateral malleolus is pushed off by exorotation of the talus. Two main classification systems are used to group the various ankle fractures: the Weber and the Lauge-Hansen Ankle (LH) classification schema. transsyndesmotic lateral malleolus with medial lesion and fracture of the posterolateral rim of the tibia. If the fracture is displaced, then it is often associated with other hindfoot injuries. X-ray diagnosis is necessary using standard AP and lateral x-rays of the ankle and foot, with supplementary Canale views. Medial malleolus fracture and/or deltoid ligament tear; Unstable; Simultaneous interosseous membrane tears [1] Special forms. The medial malleolus is the largest of the three bone segments that form your ankle. Now we notice the subtle avulsion of the medial malleolus (red arrow). Avulsion of the lateral malleolus; Oblique fracture of the medial malleolus (uncommon) Weber B = Transsyndesmotic. There are three main types of Weber fractures (A,B, and C). The Lauge-Hansen Ankle Fracture Classification. This classification is based on the level of fibula fracrture. Lateral malleolus fracture (Weber A) 2: Add vertical medial malleolus fracture: Pronation External rotation: Deltoid ligament under stress in pronation. Avulsion of a bony fragment from the posterior tibial margin (Volkmann triangle) [4] Pilon fracture: fracture of the distal tibia that involves the tibial part of the talocrural joint and is frequently associated with fibular fractures; Clinical features. According to Lauge Hansen the oblique fibular fracture indicates that this is a Supination Exorotation … 3. McGovern Medical School XR R Ankle •Comminuted, impacted pilon fracture of distal right tibia •Definition: Pilon fracture is a type of distal tibial fracture involving the tibial plafond. Differential diagnosis Explore. ... A,Di Cesare E,Zappia M,Guglielmi … Radiographic findings of obvious ankle instability may include significant fracture displacement, subluxation or dislocation of the talus under the plafond, and widening of the medial joint space. Supination. A stage II is considered an unstable ankle fracture. 1: Deltoid ligament rupture (medial mortise widening) 2: Add anterior tibiofibular ligament rupture: 3: Add spiral or oblique distal fibular fracture (Weber C) 4: Add posterior tibiofibular ligament rupture, or posterior malleolar fracture: Pronation Abduction Maximum change was noted in trimalleolar fractures followed by bimalleolar and unimalleolar. In the Lauge-Hansen classification this is an avulsion of the lateral malleolus (stage 1) as a result of the supination position of the foot and a push-off fracture of the medial malleolus (stage 2) as a result of an adduction force applied by the foot. When radiographs of the ankle are normal, however, stress views are extremely important in evaluating ligament injuries . Patella baja: rupture of the quadriceps tendon. In 20% of fractures the foot is in pronation with maximum tension on the medial side. Talofibular ligament sprain or distal fibular avulsion fracture Vertical medial malleolus fracture and impaction of anteromedial distal tibia. Here, we study the fracture pattern, mechanisms, and recommendations for … They described fractures as affecting the anterior or posterior colliculi, or being supracollicular in morphology. Fibrous joint and is amphiarthrodial (slightly moveable) of the syndesmosis type. Fracture of the fibula below the level of tibial plafond. Eponymous Types. On the right image the medial malleolus is pulled off by the medial collateral ligament due to pronation of the foot. Posterior pilon fractures involve the medial malleolus (MM). Fig. Fractures of the posterior malleolus and anterior tibial (Chaput) tubercle may be associated. The injury mechanism, fracture morphology, surgical … The proposed mechanism is avulsion at the talar attachment of the posterior tibiotalar ligament with the ankle in dorsiflexion and pronation ( 30 ). 27.6 ). Classification of Malleolar Fractures Lauge-Hansen Classification. Most of the changes took place in AO 44 type C followed by types B and A. medial rupture or avulsion, high fibular fracture and finally a posterior malleolar fracture. See also the next image. Trimalleolar fracture is a fracture of the lateral malleolus, medial malleolus, and posterior aspect of the distal tibial articular surface. There are two major classification systems for ankle fractures: the Weber/AO classification and the Lauge-Hansen classification (more complex). The supination-external rotation injury pattern has an initial anterior inferior tibiofibular ligament injury (stage 1) followed by fibula (stage 2) which could lead to PITFL or fracture of the …

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