A trimalleolar fracture is a threepart break of the ankle. This technique emphasizes the use of plates, screws, and wires as needed to achieve rigid fixation. The posterolateral approach for fixation of posterior malleolar fractures long 2 years ago a case of a trimalleolar fracture is presented, along with surgical indications and objectives. My recovery from a trimalleolar ankle fracture compleat. An ankle can be fractured while participating in high impact sports, but they are just as commonly caused by simple falls. It also depends upon your overall health and immunity state. Fragmentspecific fixation of trimalleolar fractures utilizing the. On the inside of the ankle, the lower end of the shin bone, or tibia, forms a knob of bone called the medial malleolus. My foot got stuck in some sticky mud and i fell over sideways. Open reduction and internal fixation of a trimalleolar. The recovery time following surgical treatment for trimalleolar fracture can take up to 3 to 4 months. Breaking a bone is always painful and includes inherent recovery time, but trimalleolar ankle fractures present special challenges in this post we will look at who is at risk for trimalleolar ankle fractures and examine the treatment protocol.
Apply inline traction while splinting quigley maneuver pulls great toe up and medially most fractures requiring reduction will need surgical management. This chapter focuses on the clinical presentation, diagnosis, treatment options, and longterm prognosis of trimalleolar ankle fractures utilizing both retrospective and prospective data ranging from 1975 to 2017. The majority of patients were white, female, and younger than 50 years old. Edition in good condition, may show traces of usage. Doctor answers on symptoms, diagnosis, treatment, and more. Orthopedic trauma incl pediatrics your digital gateway to expertise, education, and innovation. Trimalleolar fractures involve fracture of the medial malleolus and fibula, along with fracture of the posterior lip of the articular surface of the tibia. The trauma is sometimes accompanied by ligament damage and dislocation the three aforementioned parts of bone articulate with the talus bone of the foot. There are two treatment options for the trimalleolar fracture, nonsurgical and surgical. The difference between bimalleolar and trimalleolar fractures on the distal end of the tibia and fibula a lump of bone develops into a malleolus or malleoli singular. Fragmentspecific fixation of trimalleolar fractures utilizing the posterolateral.
This procedure involves surgical treatment of both a fractured medial malleolus and lateral malleolus. The layout of the book may be found convenient by some readers, irrational and perhaps irritating. A trimalleolar fracture is an unstable type of ankle fracture. Posterior malleolar fractures wheeless textbook of orthopaedics. Alternatively, the patient may be placed in the lateral decubitus position if there is no medial malleolus fracture. I was home alone and had to crawl about 50 yards to the. In this study, 16 per cent of the fractures were lateral malleolar, 45 per cent were bimalleolar, and 39 per cent were trimalleolar. The dislocation was reduced in the emergency room and he was admitted for elevation, icing and surgical stabilization.
The trauma is sometimes accompanied by ligament damage and dislocation. Do you want to use the redesigned ao sr like an app. We discussed with the patient and his family the procedure, the postoperative protocol and that he will be 6. Planning and reduction technique in fracture surgery. Surgical technique surgery was usually performed in the prone position, although patients could lie on their sides if the medial malleolus was not fractured. Wyman jr a 63yearold housewife fell in a store approximately 15 minutes before admission to the emergency ward of the massachusetts general hospital. Ankle trimalleolar fracture orif operative sample report.
Pdf fractures of the posterior malleolus can occur in conjunction with fibular. These bony projections are used by tendons to create a pulley effect, enabling them to generate the greater force required to move and control the anklefoot complex. In general, stable and unstable ankle fractures can be managed nonsurgically or surgically, respectively. Malleolar fracture management can be summarized into three general approaches. All plates are lowprofile, with recessed holes that allow for a locking or nonlocking screw to be placed. A hip fracture is a break in the upper quarter of the femur thigh bone. Excessive inversion stress is the most common cause of ankle injuries for 2 anatomic reasons.
Each fracture can be treated with the same surgical techniques as written above for each individual fracture. A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months. Im still in physical therapy although coming to an end, only one week left. Talbot has received speaker fees from synthes and an educational. I had a trimalleolar fracture in november at the age of 44. Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. Trimalleolar fractures hohman rehab physical therapy. Hello i fell 5 feet and landed on my right ankle breaking it tri malleolar fracture, this was 4 months ago. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus.
Tibial shaft and fibula fractures typically result from highenergy trauma such as motor vehicle and skiing accidents. The extent of the break depends on the forces that are involved. Strictly speaking, there are only two malleoli, but the term trimalleolar is used nevertheless and as such is a misnomer. The section on ankle fractures, for example, is perhaps more appropriate for a trainee orthopaedic surgeon than a student, but here, as in other places, it was felt that the subject could become almost meaningless if less detail was included. I am a registered nurse who has specialized in pain management for the last 10 years. Material and methods over a 6 year period 10 patients with an ankle fracture involving more than 25% posterior malleolus were admitted for surgery, which was performed by the first author. Trimalleolar fractures refer to a threepart fracture of the ankle. If you dont want to wait have a look at our ebook offers and start reading immediately. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. This type of fracture commonly mandates open reduction surgery often requiring the insertion of plates, screws and kwires. Material and methodsover a 6 year period 10 patients with an ankle fracture involving more than. Weaver walks us through the surgical management of a 23yearold male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a. The severity of the ankle fracture was defined as a single lateral malleolar fracture, bimalleolar, and trimalleolar fracture.
Ct of a victim of a car accident demonstrating a comminuted fracture of tibia and fibula distal fibula weber c and medial malleolar tibial fracture. Trimalleolar fracture dislocation jama jama network. In the case of elderly patients who could not tolerate surgery in the prone position, they started surgery in a lateral position and subsequently the brackets were removed and they were changed to the supine position for the synthesis of the medial malleolus. We help you diagnose your malleoli case and provide detailed descriptions of how to manage this and hundreds of other pathologies.
Trimalleolar ankle fracture with internal fixation. Pdf operative treatment of posterior malleolar fractures. Trimalleolar fracture consists of breaking both the medial and lateral malleoli and the posterior, bony process of the tibia at the level of the ankle. The approach allows one to address the fragment in a manner consistent with the classic fracture pattern that is parallel to the transmalleolar axis and, thus, posterolateral. Although the surgical approach and techniques to reduce and fix this fracture are. Many approaches and techniques have been used for the surgical treatment. The fragment should be opened in book form for direct inspection of the joint. The large posterior malleolus fragment seen in many unstable trimalleolar ankle fractures can be safely and effectively approached through the posterolateral approach to the ankle. The posterolateral approach to the posterior malleolus. Left xray of syndesmotic injury with lateral malleolus fracture. The most common ankle joint fracture patterns are lateral malleolar, bimalleolar, and trimalleolar fractures. Trimalleolar fracture complications things you didnt know. The higher the energy on impact, the more softtissue and bone damage occurs, including concomitant damage to the ankle e.
Problems associated with ankle fractures after surgery. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond referred to as the posterior malleolus and the lateral malleolus. Orif of trimalleolar ankle fractures using the posterolateral approach. Trimalleolar fracture is defined as fracture of the medial and lateral malleoli and the posterior tip of the tibia. The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. A thinner bone known as the fibula runs down the outside of the lower leg and at the end it forms a bump called the lateral malleolus. Trimalleolar fracture, type b, with depressed articular area a. This is usually a very unstable fracture and typically requires surgical intervention because there is. This approach allows for thorough debridement of the fracture and ankle joint and anatomic reduction of the posterior malleolus with secure plate fixation on the posterior tibia. Posterolateral approach in trimalleolar ankle fractures. If there is such a fracture, the prone approach must be used for simultaneous access to the medial side.
First, the medial malleolus is shorter than the lateral malleolus, allowing the talus to invert more than evert. Malleolar fractures and soft tissue surgical technique can j surg, vol. It is most always a devastating, debilitating and life altering injury. Second, the deltoid ligament stabilizing the medial aspect of the ankle joint offers stronger support than the thinner lateral ligaments. Its been a really long time since ive added any content to my blog and decided that with all i have learned in the last six months i wanted to get this information out to anyone who may be researching what recovery is like for an athlete who has suffered a. This was possible by a slight book opening technique in a. Nonsurgical treatment would be recommended only if surgery would pose too high of a. The code is not valid for the year 2020 for the submission of hipaacovered transactions. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Unstable ankle fracture that are displaced fracture of the lateral malleolus and most bimalleolar or trimalleolar fractures need surgical reduction and fixation. The posterior malleolus, or third malleolus, is formed by a lip of. Paragon28 ankle fracture plating system orthopedic.
Stable fixation of posterior malleolus in trimalleolar fractures plays a vital role in. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Ankle fracture postop rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Bimalleolar and trimalleolar fractures ace physical. This means that one or more of the bones that make up the ankle joint are broken. The patient is a xxyearold male who twisted his left ankle sustaining a trimalleolar ankle fracture dislocation. Fractures of the foot and ankle a clinical casebook nirmal c. Despite high incidence of ankle fractures in the elderly, studies evaluating outcome and impact of quality of life in this age group specifically are sparse. The standard indication for fixing a posterior malleolar fracture is a displaced fragment. My recovery from a trimalleolar ankle fracture february 6, 2014 by carla weier.
Examination of the left ankle revealed an external rotation, abduction deformity, and moderate swelling. The three aforementioned parts of bone articulate with the talus bone of the foot. Open reduction and internal fixation of a trimalleolar ankle fracture. Buy used on clicking this link, a new layer will be open.
I wont go into the details of the rest of that day but xrays showed three fractures in my left leg. I could see from the images how my ankle was clearly unstable and i would need surgery. Outcome and quality of life after surgically treated ankle. The aim of this study was to evaluate outcome and quality of life 6 and 12 months after injury in patients 65 years or older who had been operated on due to an ankle fracture. Elrod, in acute care handbook for physical therapists fourth edition, 2014. A plate with 8 screws on the outside of my ankle and 2 long screws on the inside.
Surgery is performed in the prone position with a bump under the ipsilateral hip. The purpose of this paper is to describe the surgical technique and clinical results. This may need surgery but it depends on your orthopedic surgeon as to whats the best course for you. Trimalleolar ankle fractures and open ankle fractures. Xrays of the patients ankle are taken during the recovery period in order to check if the bones still remain in alignment. They splinted and used a soft cast and sent me home.
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