Anatomy
This is the weakest lateral ankle ligament
What is Anterior Talofibular Ligament?
Name this classification system (Picture)
Rudi Classification
Name the criteria for the Ottawa Ankle Rules:
Radiograph required if pain in the malleolar zone and if bone tenderness at posterior edge or tip of lateral malleolus, bone tenderness at posterior edge or tip of medial malleolus, inability to bear weight both immediately or in ER.
What should the distance between anterior and lateral incisions be at minimum and why?
5-7mm at minimum to prevent vascular compromise of the interposed flap
Name 5 post operative complications of Pilon Fx:
What ligament is most susceptible to injury in extremes of inversion?
CFL
In the Lauge Hansen system, Fractures are categorized by a combination of ______ and _________?
Foot Position and Direction of Force
When evaluating radiographs for Pilon Fx, what are three important determinations?
Fibular Fx, Degree of Articular Comminution, Amount and location of fragment impaction.
In an Articular reduction coupled with Frame application for Pilon Fx, no attempt should be made to obtain screw or tensioned-wire stabilization across this region and why?
Metaphyseal region, because this method is associated with a high rate of nonunion when using a frame.
The most common malunion in the ankle results in what?
shortening and external rotation of the fibula.
The lateral surface of the distal tibia forms a triangular fibular notch where the tibia and fibula articulate. The posterior portion of this articulation serves as the attachment for which ligament that is orientated inferiorly and laterally?
Posterior Tibiofibular ligament
In this type of Fracture, what fails first? (Picture)
Deltoid Ligament or an Avulsion Fx of the Medial Malleolus
How many mms of widening of the medial joint space indicates a deltoid ligament injury and lateral talar translation?
4mm
When a one-third tubular plate is applied to the lateral aspect of the fibular for Danis-Weber B type fracture, What is it referred to?
Neutralization plate
The most common failure of fixation as shown in this picture?
Metaphyseal nonunion
This is fractured in a Volkmans’s Fracture and this is fractured in a Tillaux-Chaput Fx
Volkman's Fracture-Posterior Malleolus
Tillaux-Chaput Fracture-Anterolateral Tibia
Name the type of Lauge-Hansen Classification associated with hallmark fracture of a Maissoneuve fibular fracture and Volkmann fracture.
Pronation-External rotation
What should the tibial-fibular overlap be?
ORIF is recommended in posterior malleolar fractures that involves what percent of the joint?
25%
This screw is inserted 30 deg from the coronal plane from posterolateral in the fibula to anteromedial in the tibia if the medial gutter space widening is greater than 2mm.
Syndesmotic Transfixation screw
The skin overlying the distal tibia receives blood supply from what?
Perforating arteries originating from the dorsal pedis, posterior tibial and peroneal arteries.
If the foot is _______ the lateral structures are tight and the medial structures relaxed.
Supinated (inverted)
What is the talocrural angle made up of and what is the average value?
line perpendicular to the distal tibia articular surface and line connecting the ends of the medial and lateral malleoli. Average value is 83 +/- 4.
Ramsey and Hamilton postulated that a 1mm lateral shift of the Talus in the mortise reduces the contact area of the ankle by what percentage?
42%
What is an unwanted consequence of a varus malunion in a Pilon Fx?
Contracted medial soft tissue envelope