Ankle/Foot Injuries

ANKLE FRACTURES FOR WHICH ORTHOPEDIC CONSULTATION IN THE EMERGENCY DEPARTMENT IS RECOMMENDED

• Unimalleolar fractures
• Displaced medial malleolar fracture
• Medial malleolar fracture with lateral collateral ligament rupture
• Displaced lateral malleolar fracture
• Lateral malleolar fracture with deltoid ligament rupture
• Lateral malleolar fracture with widened medial clear space
• Unimalleolar fracture with syndesmotic diastasis
• Fibula fracture at or proximal to the tibiotalar joint line
• Displaced posterior malleolar fracture
• Posterior malleolar fracture involving more than 25% of articular surface
• All bimalleolar fractures
• All trimalleolar fractures
• All intra-articular fractures with step deformity
• All open fractures
• All pilon fractures
• All abnormal measurements on mortise view suggest instability of joint

Lateral Malleolar Fx

• Danis-Weber (Type A/B/C)

TriMalleolar Fx

• Fracture involving lateral malleolus, medial malleolus and the distal posterior aspect of the tibia (posterior malleolus)
• Strictly speaking, there are only two malleoli (medial and lateral), but the term trimalleolar is used nevertheless and as such a misnomer.
  

Pilon Fx


LisFranc

Lisfranc joint is made up of the articulations of the bases of the first three metatarsals with their respective cuneiforms and the fourth and fifth metatarsals with the cuboid

Lisfranc injuries may be complicated by vascular injury because a critical branch of the dorsalis pedis artery dives between the first and second metatarsals to form the plantar arch. Trauma to this vessel can cause significant hemorrhage and, uncommonly, vascular compromise.

An appreciation of normal radiographic anatomy is essential to assess Lisfranc injuries. Radiographs should be methodically examined, with assessment of alignment, bones, and soft tissues. The first four metatarsals should each line up with their respective tarsal articulation along their medial edge on anteroposterior and oblique radiographic views. The most consistent relationship is the alignment of the medial edge of the base of the second metatarsal with the medial edge of the middle cuneiform. Dorsal alignment of the tarsals with their respective metatarsals should be assessed on the lateral view.

Findings suggestive of a Lisfranc injury include widening between the first and second or second and third metatarsal bases and any fracture around the Lisfranc joint.


Fracture of the second metatarsal base (called a fleck sign), cuboid fractures, and cuneiform fractures are particularly common. A fracture of the second metatarsal base is virtually pathognomonic for occult tarsometatarsal joint disruption.



Jones vs PseudoJones