MECHANISM OF INJURY
This is produced because of severe abduction injury. The talus is shifted laterally and the inferior tibiofibular ligament is ruptured.
NATURE OF LESION
Three types of lesions may encountered:
- There may be fractures involving both the medial malleoli and lower end of the fibula along with rupture of the inferior tibiofibular ligament.
- Instead of having fracture of the medial malleolus there may be rupture of the medial ligament.
- There may not be nay fracture of the fibula but lateral talar shift along with medial malleolar fracture and rupture of the inferior tibiofibular ligament can take place.
The results produced by closed reduction are unsatisfactorily. Operative fixation is essential in these cases to ensure stability of the joint. Operative fixation requires various orthopedic implants to perform the surgery.
Basic technique of operation: The basic principles of operation are as follows:
- Insertion of screw through fibula into tibia when the medial malleolus is not fractured.
- Insertion of bone screw through both fibula and medial malleolus when both bones are fractured.
VERTICAL COMPRESSION FRACTURE OF THE ANKLE-JOINT
This type of fracture is produced after landing from a height. There may be other associated injury including fracture of the calcaneum.
NATURE OF FRACTURE
The superior articular surface of the talus strikes against the inferior articular surface of the tibia. The nature of lesion that is produced may vary according to the severity of the injury. There may be anterior marginal fracture of the distal end of tibia or severely comminuted fracture involving both the tibia and fibula with variable intensity. In serious cases the joint may be completely disruptured.
- Conservative treatment: Closed reduction on occasions may prove to be successful. Anterior marginal fracture of the distal end of the tibia can sometimes be reduced. Following reduction, immobilization is maintained by plaster cast for a period of 8-10 weeks. Check x-ray must be taken immediately after the reduction is done.
- Operative treatment: Internal fixation may be necessary in cases of failure to reduce by closed technique. Grossly comminuted fractures are unsuitable for operative fixation. The implants and instruments for the operative fixation can be obtainable from orthopedic implant companies.
Late arthrodesis: The joint at times is grossly damaged. Delayed primary arthrodesis provides a stable and painless joint.