The Hip: Preservation, Replacement and Revision

NonOperative Treatment of Ankle Fractures

- Avulsion frx of lateral malleolus (Weber A)
    - frequently does well w/ closed reduction;
    - w/ lateral and oblique medial malleolus injuries;
    - pronation of foot & abduction will reduce frx;
    - however, is an unstable pattern which requires operative Rx;

- SER/Weber B:
     - reduced by gentle distraction, internal rotation, and varus stress;
     - try placing limb in stockinette, injured side down, & then suspending free end of the stockinette, then apply cast;
             - be concerned w/ shortening and external rotation of fibula;
             - w/ an associated medial injury - may require surgery;

- Syndesmotic disruption (pronation-abduction/ext.rot or Weber C)
    - usually unstable and require operative stabilization;
    - w/ closed reduction try: distraction, inversion, & adduction;
    - lateral collateral ligaments are usually the only intact ligaments on distal fibula, and do not provide enough control of this fragment to correct and maintain fibular length and rotation;

- Indications for Treatment:
    - if in presence of medial tenderness, > 5 mm of space is seen either initially or on a stress radiograph, presumptive dx of substantial injury of the deltoid ligament can be made;
             - treat as bimalleolar frxs, w/ ORIF of lateral malleolus;
    - exploration of medial side of ankle is not necessary unless there is evidence of Deltoid Ligament disruption w/ ligament interposed in the joint, blocking reduction of the talus;

- Note: Isolated injuries of medial malleolus are uncommon and the possibility of an undisplaced lateral injury should be considered;
       - isolated fractures are treated closed if:
               - they are undisplaced
               - involve the distal portion of the malleolus
               - and can be anatomically reduced by manipulation;

- Maintenance of Reduction:
    - w/ swelling use a bulky Jones type dressing w/ plaster splints
    - stable/non-displaced ankle injuries:
    - after spinting for 3-5 days, try short leg cast: 4-6 wks;
    - wt bearing after symptoms subside;
    - w/ rotational instability: use long leg cast: 4-6 weeks, then short;
    - delay wt bearing until evidence of healing;
    - always avoid immbolization of the ankle in equinus

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, October 29, 2012 7:37 pm