INJURIES AROUND THE ANKLE (Pott’s Fracture)

INJURIES AROUND THE ANKLE (Pott’s Fracture)


INJURIES AROUND THE ANKLE

  • Injuries around the ankle fall into two groups:
  1. Ligament injuries
  2. Bony injuries

Ligament Injuries

  • Common ligaments injured are:
  1. the lateral ligament
  2. the medial or the deltoid ligament
  3. the syndesmotic ligament (ligament binding lower tibia and fibula, i.e. inferior tibiofibular syndesmosis).
  • These injuries are classified into three grades.

Grade 1—Stretching of the ligaments
Grade 2—Partial tear of the ligaments
Grade 3—Complete tear of the ligaments

Management

  • Complete and severe tears require surgical repair.
  • Less severe, strains and sprains heal well with adequate immobilization.
  • Physiotherapy and gradual mobilization is always essential for a good recovery.
Bony Injuries of the Ankle (Pott’s Fracture)
  • All bony injuries of the ankle are grouped under one eponym, i.e. ‘Pott’s fracture’.
  • Pott’s fracture is defined as a uni, bi or trimalleolar fracture with or without subluxation or dislocation of the ankle joint.
  • Ankle joint is a hinge joint.
  • Allows only the movement of dorsiflexion and plantar flexion.
  • This movement takes place in a mortise known as ankle mortise.
  • Formed by medial, lateral and posterior malleolus.
  • Any other movement occurring in the ankle joint other than dorsiflexion and plantar flexion, is abnormal 
  • Tends to injure the supporting bony and ligamentous structures, leading to deformation of the joint.
Lauge-Hansen’ Genetic Classification
  1. Abduction injuries (pronation abduction)
  2. Adduction injuries (supination-adduction)
  3. Pronation external rotation injuries
  4. Supination external rotation injuries
  5. Vertical compression injuries
  6. Unclassifiable
  1. Abduction injuries:

  • The talus abducts in the ankle mortise.
  • Abduction occurs in the vertical axis of the talus.
  • The foot is in pronation when this occurs.
  • Hence, the term pronation-abduction injury is used.

  2. Adduction injuries:

  • Talus adducts in the ankle mortise.
  • Adduction occurs in the vertical axis of the talus.
  • The foot is in supination when this occurs.
  • Hence, the term supination-adduction injury is used.
  3. Pronation-external rotation injuries:
  • Foot is in pronation while the talus rotates externally.
  • Complete failure pattern in pronation external rotation injury is either Maisonneuve or Dupuytren’s fracture-dislocation.
  4. Supination-external rotation injuries:
  • Foot is in supination while the talus rotates externally.
  • When talus supinates and rotates externally, it springs backwards and out of the ankle mortise.
  • Hence, the failure sequence that occurs is as follows:
  1. First structure to fail is the lateral malleolusStage 1
  2. Next is the posterior malleolusStage 2
  3. Last is the medial malleolusStage 3.
  • The fracture is known as a trimalleolar fracture or a ‘Cotton’s fracture’. 

  5. Vertical compression injuries:

  • Occurs when a person falls from a height.
  • The talus is violently pushed upwards into the inferior articular surface of the tibia, shattering the articular surface.

Unclassifiable injuries:

  • Nature of injury is so severe that the mechanism is unclassifiable.
  • These injuries are always compound/open injuries resulting in severe morbidity.
Management 

1. Nonoperative

  1. Undisplaced and incomplete fractures:
  • Managed with immobilization in plaster/fiber,
  • below knee or above knee cast as per indication for a period of 4–6 weeks.

2. Operative

  1. Displaced fractures:
  • Managed by open reduction and internal fixation
  • With emphasis on restoration of articular surface congruity.

Exam Important

  • Commonest ligament injured in ankle injury is Anterior talofibular ligament.
  • Injury around the ankle joint occur at Inversion of foot.
  • Ankle sprain is due to Rupture of anterior talo-fibular ligament.
  • Cottons fracture is fracture of Ankle.
  • Cotton’s Fracture involves Ankle.
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