Radiographic Evaluation, Fixation Principles, and Post-Operative Management of Ankle Fractures
Central JSM Foot and Ankle Bringing Excellence in Open Access Review Article *Corresponding author Lisa Zhang, Department of Podiatry, University Hospital, G142. 150 Bergen St. Newark, NJ 07103, USA, Tel: 908- Radiographic Evaluation, 577-2543; Email: Submitted: 15 March 2018 Fixation Principles, and Post- Accepted: 23 June 2017 Published: 25 June 2017 ISSN: 2475-9112 Operative Management of Copyright © 2017 Zhang et al. Ankle Fractures OPEN ACCESS 1 2 Lisa Zhang * and Ritchard Rosen Keywords 1Department of Podiatry, University Hospital, Newark, USA • Fracture blisters 2Department of Podiatric Surgery, Holy Name Medical Center, USA • Neutralization plate • Posterior-antiglide plate • Tension banding Abstract • Direct approach Radiographically, ankle fractures can be evaluated on the anterior-posterior (AP) view • Early weight bearing with the talocrural angle, and on the mortise view, by Shenton’sline, the dime sign, and talar tilt. Displaced fractures > 2 mm, lateral malleolar fractures that are shortened, rotated, or angulated, and bimalleolar and trimalleolar fractures require fixation. Principles of fixation include a proper soft tissue envelope without fracture blisters present at incision sites. Due to the formation of soft callus, fractures should be fixated within the first two weeks of injury. The lateral malleolus is the dominant fracture, and must be pulled out to length, which will pull other ligamentous attachments to proper alignment. Lateral malleolar fixation may be accomplished by a neutralization plate or posterior anti-glide plate; a locking plate may also be used in osteoporotic bone. Medial malleolar fixation can be accomplished by two screw cancellous fixation or tension banding, the latter especially useful in smaller, comminuted fractures.
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