Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus. Weber C fractures can be further subclassified as 6. Posterolateral corner (PLC) injuries are traumatic knee injuries that are associated with lateral knee instability and usually present with a concomitant cruciate ligament injury (PCL > ACL). Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. may be done supine with bump under affected limb or in lateral position. Physical examination shows point tenderness and swelling in the area of fracture. Fractures of the fibula often involve a syndesmotic injury (called Maisonneuve fractures). Overtightening of the ankle syndesmosis: is it really possible? Read More, Copyright 2007 Lippincott Williams & Wilkins. This type of injury is known as a stress fracture. The superficial peroneal nerve innervates the musculature of the lateral compartment and is responsible for eversion and, to a much milder degree, plantarflexion of the foot. Patients with tibia fractures, syndesmosis injuries, or ankle fractures should be referred to an orthopaedic surgeon. a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint. Posterolateral Corner Injury. The deep peroneal nerve innervates the musculature of the anterior compartment and is responsible for the dorsiflexion of the foot and toes. Treatment is generally operative reconstruction of the PLC complex and the associated ligamentous injuries when present. Treatment may be nonoperative or operative depending on patient age, fracture displacement, and fracture morphology. Boden BP, Lohnes JH, Nunley JA, et al. This type of fracture usually results from high-energy trauma or penetrating wounds. Treatment may be nonoperative or operative depending on . Diagnosis can be suspected with a knee effusion and a positive dial test but MRI studies are required for confirmation. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Question SessionAnkle Fractures & Replantation. - C2 diaphyseal fracture of the fibula, complex. Treatment is generally operative with intramedullary nailing. Sometimes they may also involve the fracture of the growth plate (physis) located at each end of the tibia. Outcome after surgery for Maisonneuve fracture of the fibula. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. Description. The injury produces pain, tenderness, and swelling of the ankle making weight-bearing difficult or impossible. Surgery may also be needed depending on the wound size, amount of tissue damage and any vascular (circulation) problems. For distal tibial fractures, fixation of the fibula: May aid in realignment or length restoration of the tibial fracture, Increases the stability of the tibial fracture repair (, Is performed with a 3.5-mm compression plate. 2023 Lineage Medical, Inc. All rights reserved. The fracture occurs from a direct blow to the outside of the leg, from twisting the lower leg awkwardly and, most common, from a severe ankle sprain. identify joint involvement and articular step-off (>25%, >2mm requires ORIF) . Are you sure you want to trigger topic in your Anconeus AI algorithm? Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures. High-energy fractures, such as those caused by serious car accidents or major falls, are more common in older children. They account for 10 to 15 percent of all pediatric fractures. Orthobullets Team Trauma - Ankle Fractures; Listen Now 38:12 min. Are you sure you want to trigger topic in your Anconeus AI algorithm? Distal tibial metaphyseal fractures usually heal well after setting them without surgery and applying a cast. Diagnosis is made with plain radiographs of the ankle. The tibia is much thicker than the fibula. Common proximal tibial fractures include: This type of fracture takes place in the middle, or shaft (diaphysis), of the tibia. Isolated fibular fractures comprise the majority of ankle fractures in older women, occurring in approximately 1 to 2 of every 1000 White women each year [ 1 ]. Fibula bone fracture is a common injury seen in the emergency room. proximal 1/3 tibia fractures account for 5-10% of tibial shaft fractures. Proximal fibula fractures - OrthopaedicsOne Articles They are also called tibial plafond fractures. At its most proximal part, it is at the knee just posterior to the proximal tibia, running distally on the lateral side of the leg where it . There will be a pain in the lower leg on weight-bearing although . Weightbearing on the involved leg may be allowed as tolerated by the patient. a combined posterior drawer and external rotation force is then applied to the knee to assess for an increase in posterolateral translation (lateral tibia externally rotates relative to lateral femoral condyle), knee positioned at 90 and external rotation and valgus force applied to tibia, as the knee is extended the tibia reduces with a palpable clunk, tibia reduces from a posterior subluxed position at ~20 of flexion to a reduced position in full extension (reduction force from IT band transitioning from a flexor to an extensor of the knee), altered sensation to dorsum of foot and weak ankle dorsiflexion, approximately 25% of patients have peroneal nerve dysfunction, may see avulsion fracture of the fibula (arcuate fracture ) or femoral condyle, side-to-side difference 2.7-4 mm = isolated LCL tear, primary varus = tibiofemoral malalignment, secondary varus = LCL deficiency with increased lateral opening, triple varus = remaining PLC deficient, overall varus recurvatum alignment, necessary to determine mechanical axis and if a, look for injury to the LCL, popliteus, and biceps tendon, coronal oblique thin-slice through the fibular head are best at visualizing the PLC structures, hinged knee brace locked in extension x4 weeks, followed by progressive functional rehabilitation, midsubstance repair have 40% failure rate following repair, repair of LCL, popliteus tendon and/or popliteofibular ligament should be performed if structures can be, anatomically reduced to their attachment site, avulsion fracture of fibular head can be treated with screws or suture anchors, avulsion injuries where repair is not possible or tissie is poor quality, goal is to reconstruct LCL and the popliteofibular ligament using a free tendon graft (semitendinosus or achilles), soft tissue graft passed through bone tunnel in fibular head, limbs are then crossed to create figure-of-eight and fixed to lateral femur to a single tunnel, trans-tibial double-bundle reconstruction, split achilles tendon is fixed to isometric point of the femoral epicondyle, one tibia-based limb and one fibula-based limb, fibula-limb is fixed to the fibular head with a bone tunnel and transosseous sutures to reconstruct the LCL, tibia-limb is brought through the posterior tibia to reconstruct the popliteofibular ligament, proximal attachment site at anatomic femoral LCL attachment, through the fibular head lateral to medial, docking into the tibial tunnel posterior to anterior with graft #2, graft #2 reconstructs the popliteus tendon, proximal attachment site at the anatomic popliteus tendon attachment, docking into the tibial tunnel posterior to anterior with graft #1, hinged knee brace, nonweightbearing for 6 weeks, range of motion protocols differ between surgeons, some advocate for passive ROM immediately 0-90, others immobilize for 2 weeks, then begin motion, at 6 weeks, begin weightbearing and closed-chain strenghtening, return to activities / sports ~ 6 to 9 months, operative treatment has improved outcomes compared to nonoperative treatment, repair has higher failure rate than reconstruction, particularly for midsubstance injuries, but also for soft tissue avulsions, anatomic reconstruction restores rotatory stability, but not all varus stability on stress testing, PLC reconstruction, +/- ACL reconstruction, +/-, acute and chronic combined ligament injuries, PLC reconstruction should be performed at same time or prior to (as staged procedure) ACL or PCL to prevent early cruciate failure, indicated in patients with varus mechanical alignment, failure to correct bony alignment jeopardizes ACL and PLC reconstruction success, ACL reconstruction + PLC repair 33% achieved IKDC grade A or B compared to 88% of patients who underwent ACL + PLC reconstruction, failure to identify a PLC injury will lead to failure of ACL or PCL reconstruction, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Proximal Tibiofibular Joint Ganglion Cysts, Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). Lateral short oblique or spiral fracture of fibula (anterosuperior to posteroinferior) above the level of the joint, 4. Generally, fibula fractures do well, and most patients have normal function at long-term follow-up (. The fibula is one of the two long bones in the leg, and, in contrast to the tibia, is a non-weight bearing bone in terms of the shaft. These types include: lateral malleolus . Mechanisms of injury for tibia-fibula fractures can be divided into 2 categories: low-energy injuries such as ground level falls and athletic injuries; high-energy injuries such as motor vehicle injuries, pedestrians struck by motor vehicles, and gunshot wounds. usually associated with an injury to the medial side Correlation of interosseous membrane tears to the level of the fibular fracture. Accept Tibia and Fibula Fractures | Johns Hopkins Medicine 2023 Lineage Medical, Inc. All rights reserved. C2: diaphyseal fracture of the fibula, complex. Similar to a nondisplaced medial malleolus fracture, a nondisplaced lateral malleolus fracture can often be treated with a short leg cast or walking boot. Nonsurgical Treatment. Open fractures of the tibia are common among children and adults. All Rights Reserved. Located posterolaterally to the tibia, it is much smaller and thinner. Tibia and fibula fractures are characterized as either low-energy or high-energy. Posterior Malleolus and Fibula Fracture ORIF - Orthobullets Fibular Avulsion Fracture - FootEducation Open reduction and internal fixation is the surgery that can be used to reposition and physically connect the bones in an open fracture. The fibula is one of the two long bones in the leg, and, in contrast to the tibia, is a non-weight bearing bone in terms of the shaft. (0/3), Level 1 A CT scan may be required to further characterize the fracture pattern and for surgical planning. Significant periosteal stripping and soft tissue injury, Significant soft tissue injury (often evidenced by a segmental fracture or comminution), vascular injury. Although tibia and fibula shaft fractures are amongst the most common long bone fractures, there is little literature citing the incidence of isolated fibula shaft fractures. The deep peroneal nerve is responsible for sensation over the first dorsal webspace. Ulnar side of hand. It is the main weight-bearing bone of the two. Then the injury is cleaned to remove any debris and bone fragments. This article focuses on the shaft of the fibula, which can be located between the neck of the fibula, the narrowed portion just distal to the fibular head, and the lateral malleolus, which in concert with the posterior and medial malleoli, form the ankle joint. Are you sure you want to trigger topic in your Anconeus AI algorithm? Obtain 3 views of the ankle (AP, lateral, and mortise) to look for ankle fracture or syndesmotic disruption. The diagnosis is made by x-raying the ankle. 2023 Lineage Medical, Inc. All rights reserved, posterior border of the biceps femoris tendon, Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine, may be done supine with bump under affected limb or in lateral position, Make linear longitudinal incision along the, may extend proximally to a point 5cm proximal to the fibular head, begin proximally and incise the fascia taking great care not to damage the common peroneal nerve, about 10-12 cm above the tip of the lateral malleolus, the superficial peroneal nerve pierces the fascia, distal - may be extended distally to become continuous with, Kocher lateral approach to the ankle and tarsus, susceptible to injury at junction of middle and distal third of leg, if injured will cause numbness on the dorsum of the foot.
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