Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Chapter 13
- 13 Fractures of the ankle
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
13 - Fractures of the ankle
from Chapter 13
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Chapter 13
- 13 Fractures of the ankle
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) FOR BIMALLEOLAR ANKLE FRACTURES
Indications
None of the existing classifications is adequate alone to dictate the treatment strategy.
Fractures with talar displacement.
Almost all bimalleolar fractures.
Pre-operative planning
Clinical assessment
Mechanism of injury: direct or, more commonly, by indirect rotational, translational and axial forces.
Soft tissue swelling, ecchymosis, tenderness.
Look for associated injuries.
Assess neurovascular integrity of the extremity.
Obtain a careful patient history.
Evaluate age, osteoporosis and systemic conditions.
Radiological assessment
High-quality anteroposterior (AP) and lateral radiographs (Fig. 13.1a,b).
Mortise view: AP in 20° internal rotation.
CT scan: for evaluation of posterior malleolus.
Assess: degree of fragment displacement, quality of bone.
Timing of surgery
Dictated by the soft tissue condition.
Before the development of soft tissue swelling or blisters.
Delayed ORIF when soft tissue injury resolves.
Operative treatment
Anaesthesia
Spinal or general anaesthesia.
Prophylactic antibiotics as per local hospital protocol.
Application of a pneumatic tourniquet to the upper thigh.
Table and equipment
AO small fragment set.
3.5 mm cortical and 4.0 cancellous screws.
Standard osteosynthesis set as per local hospital protocol.
A radiolucent table.
An image intensifier and a competent radiographer.
Table set up
The instrumentation set is at the foot end of the table.
Image intensifier is from the contralateral side.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 246 - 253Publisher: Cambridge University PressPrint publication year: 2006