If there is a lot of soft tissue swelling over the lateral malleolus, but no fracture, then there has been a ligamentous injury. Cigarette smoking and high BMI are both risk factors for ankle fractures. The locking screws which thread into the plate are designed to allow for an angle of up to fifteen-degree variation from perpendicular which is a vast improvement from more traditional locking trajectory which allowed for very little variation. Constantinou M, Brown M. Non-union distal fibula avulsion fracture in a 16 year old male: A clinical case report. These plates are anatomically contoured to specifically fit to the natural or native alignment of the distal fibula. Antibiotics will be administered to prevent infection. Ankle injuries, like many fractures have a bimodal distribution. The commonest classification is the Weber classification that uses the position of the fracture relative to the syndesmosis to group fractures: In Weber B and C fractures the syndesmosis may have been torn (partially or completely). If they are not and the talar dome is not parallel to the tibial plafond, the syndesmosis has been torn. The patient will not be allowed to walk on the ankle until post-operative X-rays demonstrate full bone healing which commonly occurs at 6-8 weeks following surgery. what is the the common treatment for this type of injury? In most cases an ankle x-ray is all that is required for diagnosis and follow up. This results in widening of the distal tibiofibular joint and loss of integrity of the socket. This is called talar shift and the ankle joint is unstable. Home care. tenderness along the posterior surface of the distal fibula, OR tenderness along the posterior surface of the distal tibia, OR inability to weightbear after the trauma and when being assessed, where the fracture is in the bone (relative to syndesmosis), what type of fracture (transverse, oblique, spiral, comminuted), whether there is displacement (translocation, angulation, rotation), whether there is another fracture (medial malleolus, talus). motor vehicle accident, sporting injury), while older patients present following minor trauma (e.g. Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures. It may include some of the following approaches, used either alone or … The syndesmosis is a strong ligament that pulls the tibia and fibula together just above the distal tibiofibular joint. A good warm-up session and maintaining strength and flexibility in the legs are the best means of protection against fibular fractures. [3–5] Recently, percutaneous minimally invasive compression locking plates have been gradually popularized, but these have been mostly applied for older children. Treatment depends on the type of distal fibula fracture which is a reflection of the severity of the fracture and the surrounding ligamentous structures. If the injury appears unstable on x-ray imaging, then the fracture requires surgery to re-establish ankle stability. The fibula has also been known to fracture in sports that involve twisting, such as basketball or skiing. The distal portion (part closest to the ankle) comprises the lateral malleolus which is the lateral buttress or restraint to the ankle joint. The Ottawa ankle rules allow evidence-based decision making regarding the need for plain films in patients with ankle injury. The fracture reduction and alignment is then permanently held in place using plates and screws which are left in place permanently unless they cause symptoms. Create an account, Enter Your Surgery Name Or Diagnosis Below. This socket is only functional because the tibia (medial and posterior malleolus) and fibula (lateral malleolus) are held together tightly by the syndesmosis. Following surgery patients will often be left in a splint to the foot and ankle for 2-4 weeks to allow for the bone to heal and the soft tissue to rest. While your fibula—the long, thin outside bone of … This system is designed with patented SmartLoc polyaxial locking technology which allows for variability in plate and screw position and trajectory, allowing the surgeon to adapt the implant to the patient’s needs. Types of treatment for a fracture Treatment depends on how severe the fracture is, the type, and where the injury is. The fracture site, or broken portion of the bone, is then identified and any damaged portion of it or the surrounding tissue that cannot be repaired is removed. One such technique is to utilize an anatomic distal fibula plate to hold the correct aligned or reduced fracture fragments in place. For the purpose of this review, we will use the Danis-Weber criteria for lateral fibula fractures. J Sci Med Sport 2012; 15:S135. Fibula Fracture Treatment Immobilization, either with CAM walker boot or surgery with screws and plates, depends on the distance between the fractured fragments. The modality most commonly utilized by orthopaedic surgeons is applying an anatomic distal fibula plate. The majority of injuries are relatively simple avulsion injuries from the fibular pole and only require immobilization with a cast. Takao M, Uchio Y, Naito K, et al. If you have been recently diagnosed, or have an established medical condition, you can now obtain unprecedented access to technologies that address your medical circumstance. Distal fibula fractures are the most common type at the ankle and are usually the result of an inversion injury with or without rotation. However, more severe injuries with ligamentous injury and ankle instability may require operative reduction and internal fixation. A pure inversion injury will result in tension being applied to the supporting soft tissues of the lateral ankle, particularly the lateral collateral ligament. Most patients present following an episode of trauma with ankle pain, tenderness and an inability to weightbear. Isolated distal fibula fractures account for up to 55-65% of all ankle fractures (4). Ankle fractures may be the result of a vast array of injuries that range from an inversion injury to a complex high trauma sporting injury. Patients will most commonly follow-up with their surgeon at 2 weeks following surgery to have their sutures of staples removed and then again at 6 weeks for X-rays to assess for fracture healing.
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