Lateral malleolus fracture picture11/28/2023 ![]() ![]() Type 2: dorsolateral to plantomedial fracture with medial forefoot displacement. Type 1: coronal fracture with no dislocation. Sangeorzan Classification of Navicular Body Fractures ![]() The navicular bone is particularly at risk for avascular necrosis, difficult to diagnose, and therefore a high index of suspicion is required to identify this injury. Significantly displaced fractures often require orthopaedic intervention. The majority consist of minor avulsion or stress fractures. Most isolated midfoot fractures affect the navicular or more rarely the cuboid bones. Koval, K & Zuckerman, J (2002) Handbook of fractures, Philadelphia: Lippincott Williams and Wilkins.Pain from the fracture and restriction of movement is usual for 2-3 weeks and will require regular, then prn analgesia Malunion may occur with a lateral malleolus fracture that is shortened or rotated, a displaced posterior or medial malleolus fracture or a talar shift.Īrthritic changes can occur due to damage at time of injury or malunion. Orthopaedic review in ED or within 1-2 days NWB.Ĭlean and dress wound, short leg backslab. CT is the best way to determine articular displacement.Ī Short leg backlsab should be applied, NWB mobility, for all posterior malleolus fractures. NWBĪs with medial malleolar fractures care should be taken to rule out any other injury about the ankle which would indicate instability.įractures that involve >25% of the articular surface or a displaced >2mm usually require an ORIF. These fractures are unstable and require ORIF. If medial malleolar injury is truly isolated then a short leg backslab should be applied and the patient is to remain NWB until orthopaedic review. Any other fracture, ligament injury or talar shift indicate the fracture is likely to be unstable and should be reviewed by orthopaedics. The entire length of the fibula should be palpated and x-rayed to rule out any Maisonneurve type injuries. With medial malleolus fractures care should be taken to rule out any other fracture or injury around the ankle. A short leg backslab, ankle at plantargrade, should be applied. These fractures should be placed in a short leg backslab and remain NWB.įibular fractures which are displaced >3mm, have associated medial malleolar fracture or medial ligament injury are unstable and require orthopaedic review. Isolated fibular fractures at the level of the syndesmosis (Weber B) without associated medial injury should be placed in a short leg backslab (ankle at plantargrade) and remain NWB.įractures above the syndesmosis (Weber C) involve disruption of the syndesmosis and are usually associated with medial ankle injury. Talar shift or widening of the mortice indicates instability.įractures below the syndesmosis (Weber A avulsion type injuries) without associated medial ankle #/tenderness can be treated in a walking/CAM boot and may mobilise WBAT. Fractures distal to the syndesmosis are unlikely to be associated with ligamentous injury and therefore likely to be stable.įibula fractures that are associated with medial fractures or medial ligamentous injury are likely to be unstable despite normal alignment on x-ray. ![]() The stability of a fibula fracture determines treatment.
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