TOTBİD Dergisi

TOTBİD Dergisi

2013, Cilt 12, Sayı, 2     (Sayfalar: 153-158)

Fractures around the ankle

Mustafa Seyhan 1

1 Acıbadem Kadıköy Hastanesi Ortopedi ve Travmatoloji Bölümü, İstanbul

DOI: 10.5606/totbid.dergisi.2013.17
Görüntüleme: 106
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İndirme : 123

Ankle fractures are the most frequently seen fractures in Orthopedic Traumatology practice, mostly resulting from low-energy rotational traumas. The need for radiological examination for ankle injuries should be determined according to the Ottawa rules. The standard trauma series include anteroposterior, lateral and mortise views. When necessary, stress graphs, computed tomography (CT) or magnetic resonance imaging (MRI) may be performed. The most commonly used classification systems for ankle fractures are the AO/Weber system which is based on the level of the fracture in the lateral malleolus and the Lauge- Hansen system based on injury mechanism. Most fractures are stable isolated malleolus fractures and are treated conservatively. Displaced unstable fractures require surgical treatment. The state of soft tissues is critical in the timing of surgery. In complex injuries, surgery usually starts at the level of the lateral malleolus. The anatomic reduction of the lateral malleolus provides extension. Lag screws, 1/3 tubular or anatomic plates may be used for the osteosynthesis of lateral malleolar fractures. Anatomic reduction is also required for fractures of the medial malleolus, which often needs two 4 mm partially threaded cannulated screws. Repairing fully ruptured deltoid ligament is essential for stability. Fractures of the posterior malleolus which involve more than 25% of the joint surface are fixed either with the direct posterior approach or with the indirect method using a lag screw from anterior to posterior. After fixation of the lateral malleolus during surgery, syndesmotic stability should be evaluated using intraoperative stress test under scopy. Syndesmosis injury should be fixed with reduction. Rigid fixation needs three or four cortices with one or two 3.5 or 4.5 mm screws. Syndesmotic screws should be removed at three months maximum. Flexible fixing materials which are used as alternatives to screws are considered more physiological, despite their biomechanical adequacy is questioned. Complications of ankle fractures include loss of position, skin problems, infection, nonunion, malunion, delayed union, arthrosis, synostosis, reflex sympathetic dystrophy and compartment syndrome.

Anahtar Kelimeler : Ankle fractures; ankle; fracture; mortise; syndesmosis