$bimalleolar fracture$

Bimalleolar fracture full#

Clinically it may be very difficult to differentiate a fracture from a severe sprain without an X-ray unless there is obvious distortion or instability.

$bimalleolar fracture$

Not everyone with an ankle injury needs to have an X-ray. Examination of the uninjured ankle may give an indication of the normal range of movement and power.Specific tests of tendon function are listed in the separate Ankle Injuries article.Check for tenderness (fracture) of the proximal fibula.Pay special attention to the ipsilateral knee and foot.These cannot be tested in most cases as the joint may be swollen, painful, fractured or dislocated.Sural nerve and peroneal nerve palsies are a rare complication of severe sprains. Vascular compromise is the urgent concern in dislocations and fracture-dislocations. Assessment of neurovascular status is by sensation over the dorsal and plantar surfaces of the foot, measuring capillary refill in all digits, and palpating the distal pulses (the dorsalis pedis artery is absent in 2-3% of the population).Palpate for crepitus and tenderness, especially over the malleolar regions, over the anterior tibiofibular ligament, the whole length of the fibula and the base of the 5th metatarsal.Is an effusion present? This may be a fullness either side of the Achilles tendon.Is there swelling or bruising? Does it look compatible with the mechanism of injury?.Did the patient walk in? If so, with how much discomfort and disability?.The patient should also be assessed and examined for co-existing injuries. Features that may suggest a fracture include obvious deformity, swelling, bruising, inability to weight bear and bony tenderness. Is specialist orthopaedic referral needed?Īnkle fractures and ankle sprains can present in a similar way.Is there a history of osteoporosis or of risk factors for osteoporosis?.Are there associated injuries (ligamentous, capsular, vascular)?.Did the ankle swell? Was the swelling immediate? (Immediate swelling is due to bleeding.).

$bimalleolar fracture$

What happened afterwards? Was the patient able to weight bear immediately? Did they need help to walk? If it was a sports injury, were they able to continue?.

What was the mechanism of injury (inversion, eversion, plantar flexion, dorsiflexion)? This can help to determine the nature and severity of the injury.

When assessing ankle fractures, consider: The deltoid ligament joins the medial malleolus to the talus, calcaneus and navicular bones. The talus is joined to the calcaneus by the calcaneo-fibular ligament. The anterior and posterior talofibular ligaments join the fibula to the talus. The distal fibula is joined to the distal tibia by the anterior and posterior inferior tibiofibular ligaments, an inferior transverse ligament and a syndesmosis ligament. The joint capsule and the surrounding ligaments stabilise the ankle. The distal fibula is known as the lateral malleolus. The distal tibia has a prominent medial malleolus and a less prominent posterior malleolus. This joint allows inversion and eversion of the ankle.

The subtalar joint - articulation is between the talus and calcaneus.

This joint allows dorsiflexion and plantar flexion of the ankle.

The true ankle joint (tibiotalar joint) - articulation is between the lower end of the tibia, the malleoli and the body of the talus.

See the separate Ankle Injuries article for the assessment of ankle fractures and sprains (this details the history, examination, investigation and differential diagnosis of ankle injuries and the management of ankle sprains and strains). However, obvious clinical deformity (ie dislocation) or injuries with neurovascular compromise of the foot are an orthopaedic emergency, for which immediate reduction is required (see 'Management' section, below). Many ankle injuries are managed conservatively.

Bimalleolar fracture full#

The ankle takes the full weight of the body and is subject to considerable force, particularly in running and jumping. This allows locomotion and balance on both level and uneven ground.

$bimalleolar fracture$

The ankle is a complex joint that is capable of a wide range of movement: flexion, extension, inversion and eversion as well as a combination of these movements. Tibiofibular joint - fibrous joint held together by ligaments (syndesmosis joint).Ankle joint - where the tibia, fibula and talus meet.Two joints are involved in ankle fractures: An ankle fracture is a break in one or more of the bones of the ankle joint - the tibia, fibula and talus.

$bimalleolar fracture$