Ankle Fractures POTT

1
Ankle FracturesPOTTS FRACTURE
2

• Malleolar Fractures
• Injuries about the ankle joint cause destruction
  of not only the bony architecture but also often
  of the ligamentous and soft tissue components.

3
Anatomy
4
Mechanism of injury

• The patient stumbles and falls with the foot
  anchored to the ground and the body with the
  ankle joint twists.

5
Mechanism of injury

• There may be fracture of one or both malleoli or
  one malleolus and the opposite ligaments.
• If the malleolus
• pushed the fracture
• is oblique if its pulled the
• fracture is transverse.

6
Danis -Weber classification

• Based on the location and appearance of the
  fibular fracture
• Type A caused by internal rotation and
  adduction that produce a transverse fracture of
  the lateral malleolus at or below the plafond,
  with or without an oblique fracture of the medial
  malleolus.

7

• Type B caused by external rotation that results
  in an oblique fracture of the lateral malleolus.
• The injury may include rupture or avulsion of the
  anteroinferior tibiofibular ligament, fracture of
  the medial malleolus, or rupture of the deltoid
  ligament.

8

• Type C fractures are abduction injuries with
• oblique fracture of the fibula proximal to the
  disrupted tibiofibular ligaments medial
  malleolar fracture or a deltoid ligament rupture.
• Fracture of the posterior malleolus may
  accompany type C fractures.

9
Clinical features

• Skiers, footballers, climbers and RTA.
• Pain, inability to stand, swelling, deformity,
  echymoses and skin blistering.

10

• X-ray AP, lateral, 30 oblique views of the
  ankle (mortise).
• Lateral and medial malleolus, posterior tibial
  edge (posterior malleolus), tibio fibular
  syndesmoses (diastases).

11
Treatment

• Principles
• Dont delay.
• Treat the bony and ligament injuries.
• Accurate reduction and maintaining it.
• Conservative treatments
• Used for non displaced type A and B injuries.
• Below knee posterior slab for 5 days with
  elevation, then check X-ray if still non
  displaced full POP cast for 6-8 weeks.

12

• Operative treatments
• For displaced type A B and all type C Injuries.
• Open reduction and internal fixation in steps
• Lateral malleolus
• Perfect reduction and fixation by plate and
  screws (most important step).
• Medial malleolus
• Reduction after removing the periostium and
  fixation by two malleolar screws.

13

• Transverse screw if the syndesmoses is unstable.
• Posterior malleolus if large fix by one screw.

14

• Postoperative treatment
• Below knee posterior slab for 5 days with
  elevation, followed by full POP walking cast for
  6-8 weeks.
• Complications Early
• Vascular injury if fracture subluxation of the
  ankle joint.
• Wound breakdown and infection.
• Late
• Malunion.
• Non union (medial malleolus).
• Stiffness.
• Osteoarthrits.