A talar shift of 1 mm results in a 42 percent decrease in tibiotalar contact area, which can lead to significant increases in contact stress. The deltoid ligament, which runs from the medial malleolus to the calcaneus, talus, and navicular bones, plays a vital role in maintaining correct talus positioning. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular ligaments and the deltoid ligament. Any bi- or trimalleolar fracture should be considered unstable because of the disruption of the bony architecture on both the medial and lateral side of the joint. Unstable ankle fractures are one of the primary indications for orthopedic referral. In general, most stable ankle fractures can undergo nonoperative management by a primary care physician. The primary consideration regarding need for operative management of a closed ankle fracture is stability. The focus of this article is to help emergency physicians choose the proper method for determining that stability. 3 These type B fractures are sometimes stable, and patients can ambulate on them as tolerated in other cases, they are unstable and require open reduction and internal fixation (ORIF). Weber B fractures occur at the level of the tibiofibular ligaments, just above the talar dome, and happen primarily through a mechanism of ankle supination and external rotation (SER). Weber C fractures are almost always unstable and require surgical intervention. Weber C fractures are above the ankle joint and are associated with a syndesmotic injury. Injuries to the distal fibula, below the talar dome, are classified as type A and are stable fractures. Tips for Diagnosing Occult Fractures in the Emergency DepartmentĮxplore This Issue ACEP Now: Vol 39 – No 04 – April 2020.Tips for Catching Commonly Missed Ankle Injuries.Tips for Managing Suspected Occult Fractures.It can be performed by anteroposterior screw fixation after reduction and temporary K-wire stabilization or with posterolateral, posteromedial or combined approaches including a small buttress plate in case of larger fragments 1,5. posterolateral injury with concomitant fibular fractures for better restoration of the syndesmotic structure 1,4.posterior talar subluxation or other signs of tibiotalar instability.significant posterior malleolar fragment size or articular surface (20-25%) involved.Open reduction and internal fixation are usually performed after concomitant medial and lateral malleolar fractures or injuries have been reduced and fixed under the following conditions 1: simple, fragmentary, intercalated fragments.the extent of involvement of the articular surface.location of the fragment (posteromedial, posterolateral). ![]() ![]()
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