Treatment of nonunions after malleolar fractures foot and ankle. There are limited data reporting the outcome of patients with nonoperatively managed medial malleolus fractures compared to those treated surgically in the presence of fibular stabilisation for unstable fractures of the ankle. The purpose of this study is to determine if any difference exists in. Figure 1 shows the diagram of the lateral malleolus. This type of fracture is typically seen with patients who have had rotational forces acted on the leg or after landing from a forceful and impactful jump. Undisplaced and minimally displaced isolated lateral malleolar fractures. Studies have shown 3 that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities.
Whilst uncommon with malleolar fractures, non union can occur. Recurrent ankle sprains secondary to nonunion of a lateral. May 08, 2017 a medial malleolus fracture is a crack or break in the medial malleolus plural form. Surgery is required internal fixation screwsplate if fracture is displaced and unstable. Recurrent ankle sprains secondary to nonunion of a lateral malleolus fracture article in the journal of foot and ankle surgery 421. There are three locations of fractures involving the fibula, based on their relationship to the ankle joint line. Malleolar epiphyseal fracture is one of the most common clinical injuries of the ankle joint, accounting for approximately 11% of epiphyseal injuries in children 1,2,3. Lateral malleolus fractures are the most common type of ankle fracture.
In addition, surgery has a chance of both infection and healing problems about 2 percent and these can cause significant problems. Nonunion distal fibula avulsion fracture in a 16 year old. Management is determined by the location of the fracture and its effect on balance and weight bearing. If palpation reveals tenderness below, rather than over, the lateral malleolus and the athlete is able to bear weight, there is a 97% probability of soft tissue injury alone vargish and clarke, 1983. Manual stress requires time and more radiation exposure. Surgical treatment of nonunion is usually focused on three goals. Symptoms fractures are acute injuries occur suddenly therefore symptoms can often be noticed immediately following injury. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities a trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior. The patient was managed conservatively with a below knee full cast and was kept nonweight bearing. Treatment for nonunion involving the lateral malleolar. Symptoms of ongoing lateral malleolus pain and nonunion.
Ideally, the lateral malleolus fracture should be of a transverse or short oblique configuration. The weber ankle fracture classification or danisweber classification is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint. A lateral malleolus fracture is an injury involving a complete break in the boney prominence located at the outer aspect of the ankle i. Small bone fragment at the inferior portion of the lateral malleolus is consistent with an avulsed fracture. This rare injury cannot be classified by commonly used salter harris classification for epiphyseal injury. Nonunion of distal fractures of the fibula type weber b is rare. Lateral malleolus definition of lateral malleolus by. Cannulated screw and kirschner fixation for the treatment.
Management of isolated lateral malleolar fracture new page 2. Lateral malleolus fracture healing time, treatment, icd. Ankle fractures and ta ruptures are common as isolated lesions. Conservative management could result in fewer complications, reduced surgical time and lower cost. Percutaneous screw fixation for painful nonunion of. The true incidence of the nonunion of the fibula lateral malleolar fracture in conjunction with ankle injury and fibula fracture in conjunction with a tibial shaft fracture is difficult to determine because most remain asymptomatic and, therefore, unrecorded. Stable lateral malleolus fractures of the ankle are typically treated nonoperatively with cast or boot immobilisation and early weight bearing. At 5year followup, the fracture was united but the patient still showed clinical signs of. The reason is that non surgical treatment has been shown to be just as effective for the treatment of the broken bone. This usually occurs in association with a traumatic force such as a rolled ankle or a direct blow and causes a sudden onset of intense pain in the area. The nonunion was debrided, bone grafted, and internally fixed by using the tension band wire technique. In his remarks on fractures and dislocations 1769 pott gives a detailed account, with illustrations, of the fracture of the lateral malleolus of the fibula with dislocation of the ankle and fracture of the tip of the medial malleolus of the tibia and states what is true today, that in its most simple state, unaccompanied by any wound, it is extremely troublesome to be put to.
Establishing a healthy vascular area of bone and soft tissue around the fracture site. Accessory ossicle or intraepiphyseal fracture of lateral. Disp fx of lateral epicondyle of r humerus, init for opn fx. Stable lateral malleolus fractures of the ankle are typically. Conditions that can be related to lateral malleolus fracture include.
Operative treatment of nonunion following distal fibula and medial malleolar ankle fractures. Plaster immobilisation of a stable fracture leads to secondary bone healing with fracture callous 5. Fracture union was diagnosed by resolution of pain and swelling, with a return to full weightbearing mobilisation and twoview radiographs consistent with union. Cureus isolated lateral malleolar fracture treated with. By continuing to use this site you consent to the use of cookies on your device as described in our cookie policy unless you have disabled them. Lateral malleolus nonunion can cause pain and loss of function. Ankle lateral malleolus avulsion fracture with os subfibulare. A fracture is the medical term used for a broken bone.
Weber b fractures stable if undisplaced and mortice intact full below knee plaster with crutches re xray at 1 2 weeks plaster for 6 weeks total x ray at 6 weeks out of plaster clinical union no pain avhap educational talk 28 june 2011, duy thai. Treatment for nonunion involving the lateral malleolar fracture. A lateral malleolar fracture takes aproximately 68 weeks to heal if properly immobilized and non weightbearing. Percutaneous screw fixation for painful nonunion of lateral.
Within the present study, a 19yearold female who sustained an isolated lateral malleolar fracture was treated with open reduction and intramedullary mg screw fixation and. Lateral malleolus fracture healing time, treatment, icd 9. Fractures can occur at different levels of the medial malleolus. Pediatric ankle fractures orthopaedic trauma association. Fibular fracture may occur in conjunction with fractures of the tibia or as a component of malleolar fracture of the ankle. Lateral malleolus an overview sciencedirect topics. There are 3 bones that makes up the ankle joint and the lateral malleolus is the area that is the most frequently fractured part of the ankle 1, 2. Know the assessment, goals, related factors, and nursing interventions with rationale for fracture in this guide. A bone can fracture in different ways, causing complications or secondary conditions that your physician will look for. Sep 12, 2019 there are limited data reporting the outcome of patients with non operatively managed medial malleolus fractures compared to those treated surgically in the presence of fibular stabilisation for unstable fractures of the ankle. Several noninvasive methods are available, such as electrical stimulation or specialized braces. The bony knobs on the inside and outside of the ankle are called the malleoli, which is the plural.
Children remodel avhap educational talk 28 june 2011, duy thai. Several non invasive methods are available, such as electrical stimulation or specialized braces. Nov 28, 2019 the clear answer is that surgery is a worse option for stable lateral malleolus fractures. Medial malleolus fracture symptoms, treatment, causes. As your ankle was pushed over by the horse, the ligament pulled a piece off the tip but it remained in place so should heal well. Although less common, accessory ossicle of the malleoli is an important differential diagnosis for such injury. It may also involve injury to a ligament of the leg. Fracture of the lateral malleolus twin boro physical therapy. Plain radiographs of anteroposterior, mortise and lateral views revealed a fracture of the medial malleolus with no other bony injuries.
A lateral malleolar fracture occurs as a result of the twisting of the foot or ankle resulting from tripping or falling. Weber classification of ankle fractures dr jeremy jones and assoc prof frank gaillard et al. A lateral malleolar fracture takes aproximately 68 weeks to heal if properly immobilized and nonweightbearing. A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. Plain anteroposterior and lateral radiographs of the left ankle revealed a nondisplaced, short, oblique fracture of the lateral malleolus, danisweber b. Ankle fractures lateral malleolar fractures non operative treatment 2. A lateral malleolus fracture is a fracture involving only the fibula bone at or near the ankle.
Instability, loss of reduction, nonunion or infection was not observed in these patients. Nov 29, 2008 treatment for nonunion involving the lateral malleolar fracture answered by a verified health professional we use cookies to give you the best possible experience on our website. Clinical union precedes radiological union by 4 6 weeks 6. Open right humerus lateral epicondyle upper arm bone fracture icd10cm diagnosis code s42. Non union of distal fractures of the fibula type weber b is rare. A lateral malleolus muhleeuhlus fracture is a type of broken ankle that happens when part of the fibula just above the ankle joint fractures. The most common joint that is injured in playing sports is the ankle and this may cause pain in the affected leg. Doctor answers on symptoms, diagnosis, treatment, and more. Metatarsal shaft fractures are initially treated with a posterior splint and. Infected nonunion dr sagar tomar llrm medical college meerut,up 2. Pediatric ankle fractures orthopaedic trauma association ota. Jan 20, 2016 plain anteroposterior and lateral radiographs of the left ankle revealed a nondisplaced, short, oblique fracture of the lateral malleolus, danisweber b. Pediatric ankle fractures the ankle is the 2nd most common site of physeal injury in children 1025% of all physeal injuries occur about the ankle.
A case of intraepiphyseal injury type 7 to the lateral malleolus in a 11 year old child is described. Some stress fractures or chip fractures can take weight but displaced fractures are too painful and unstable to walk on. Medial malleolus fracture of the ankle combined with. Displaced fracture of medial malleolus of right tibia, initial encounter for open fracture type iiia, iiib, or iiic. If reduction is difficult, the medial side should be exposed to clear any soft tissue trapped in the medial side of the ankle joint. Fracture of the lateral malleolus is also occurred when the ankle is either twisted or rolled, usually with an awkward or uneven step. Weber classification of ankle fractures radiology reference.
One study found that ankle fracture non unions comprise 6. There is an osteochondral lesion of the anterior lateral aspect of the talar dome that measures 4mm transverse by 3mm anteriorposterior. Ankle fractures involving the medial malleolus showed a higher incidence of lateral malleolar pseudoarthrosis 0. In this nursing care plan guide are 11 nursing diagnosis for fracture. However, their association in the same injury is infrequent, and there are only a few case reports.
The effect of percutaneous screw fixation of lateral. Oct 26, 2017 but a medial malleolus fracture is more often part of a compound injury involving one or both of the other ankle parts. Treatment for nonunion involving the lateral malleolar fracture answered by a verified health professional we use cookies to give you the best possible experience on our website. The lateral malleolus should be gently palpated to assess if bone pain is present. Fixation of a posterior malleolus fracture is only required if the fragment bears more than one quarter of the tibial articular surface, as seen on the lateral xray of. Weber b fracture of the lateral malleolus with concomitant. Fractures commonly happen because of car accidents, falls, or sports. Since you did hearfeel a popping in your ankle, there is a very good chance that to partially tore ligaments or did damage to the tendon that passes below the lateral malleolus.
Lateral malleolus fracture healing time, treatment, icd 9, surgery, causes, diagnosis. Undisplaced and minimally displaced isolated lateral malleolar fractures weber b. Furthermore, isolated minimally displaced lateral malleolus fractures may have unidentified medial ligamentous injury, creating an unstable fracture. Infected non union dr sagar tomar llrm medical college meerut,up 2. Nonunion of a fracture of the lateral malleolus is a rare condition. The patient was managed conservatively with a below knee full cast and was kept non weight bearing. Now there is also the issue that perhaps you do not have a fracture at all as the only way to make a diagnosis of fracture is with an xray or some other imaging modality. Risk for nonunion due to intraarticular nature of fracture risk for delayed union and late displacement rate of physeal arrest may be than the literature suggests. In the event that an individual suspects they may have lateral malleolus fracture, a radiographic evaluation xray will be essential to a proper diagnosis. What is the healing time for a lateral malleolus fracture. Magnesium mg bioabsorbable screws are new biomaterials used in fracture fixation. More frequently, ankle fractures have been described in association with tendon ruptures, such as the tibialis posterior and the flexor hallucis longus. Pdf nonunion of distal fractures of the fibula type weber b is rare.
But a medial malleolus fracture is more often part of a compound injury involving one or both of the other ankle parts. Details of type 7 intraepiphyseal injuries and accessory ossicle are. There are three locations of fractures involving the fibula, based on. The commonly used weber classification relies solely on the level of the lateral malleolar fracture relative to the ankle joint line. The true incidence of the nonunion of the fibula lateral malleolar fracture in conjunction with ankle injury and fibula fracture in conjunction with a tibial shaft fracture is difficult to determine because most remain asymptomatic and. We present a case of established nonunion of a fracture of the lateral malleolus confirmed and treated surgically, using debridement and internal fixation with autologous bone graft.
They occur when the physical force exerted on the bone is stronger than the bone itself. If the broken bone punctures the skin, it is called an open or compound fracture. A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. It is considered a threatening fracture because the injury mechanism of the distal epiphysis of the tibia and fibula is very complex, and many ankle ligaments are attached at the medial and. Undisplaced and minimally displaced isolated lateral malleolar fractures weber b usually unite without operative intervention. No or only minimal pain on the medial side was also a prerequisite. In 1930 liitzeler published the first case of nonunion of lateral malleolar fracture, and rostock, in 1938, added four on which, how. Fracture of the tip of the lateral malleolus bunnie, you have an undisplaced fracture of the tip of the malleolus. In the current literature, there is only one case report on the use of magnesium bioabsorbable screws in ankle fractures. Two weeks postoperatively, the patient attended a followup clinic, complaining of pain over the ta. Medial malleolar fractures often occur with a fracture of the fibula lateral malleolus, a fracture of the back of the tibia posterior malleolus, or with an injury to the ankle ligaments. Medial malleolus fracture of the ankle combined with rupture. The explana tion is no doubt primarily that lateral malleolar pseudarthrosis is relatively uncommon, so that only a few cases are on record.
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