- 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;
