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Ankle & Foot Injuries

  1. Ligamentous Injury
    Over 90% of ankle ligament injuries (twisted ankle or ankle sprain involve the lateral ligament complex — usually the anterior tibiofibular ligament.
  2. Ankle Ligaments
    1. Medial Collateral Ligament
      It is also called as deltoid ligament. It is strong ligament and major stabilizer of ankle joint.
    2. Lateral Collateral Ligament
      It is a weak ligament so involved in over 90% of ankle ligament injuries. It has three parts
      1. Anterior talofibular- Most commonly injured
      2. Middle calcaneo fibular- 2nd m.c. injured
      3. Posterior talofibular- Torn in most severe injuries
        Inversion injury of ankle cause peroneal tendon sheath (not extensor digitorum brevis) sprain.
    3. Inversion Injury to ankle may lead to 
      1. Lateral collateral ligament injury (anterior taloflbular > calcaneofibular > posterior — talofibular ligament)
      2. Peroneal tendon injury
      3. Avulsion fracture of tip of lateral malleolus
      4. Avulsion fracture of anterolateral surface of talus & calcaneum (sustentaculum tali). Fracture of base of 5th metatarsal.
    4. Malleolar fracture
      1. Transverse fracture of medial malleolus occurs in pronation — abduction injury i.e. the position of foot at the time of injury is pronated and the direction of force upon talus is towards abduction.
      2. If malleolus is pushed off it usually fractures obliquely; if it is pulled off, it fractures transversely.
      3. So in adduction (supination) injury: transverse avulsion fracture of fibula and vertical (oblique) fracture of medial malleolus occurs.
      4. In abduction (pronation) injury: transverse fracture of medial malleolus and oblique fracture of fibula occurs.
      5. In adduction injury the foot is supinated so called as supination - adduction injury; and in abduction injury the foot is pronated so called as pronation abduction injury.
Name of Fracture
Site of Fracture
Jefferson’s Fracture
Hangman’s Fracture
Atlas vertebrae (C1)
Axis vertebra (C2)
Clayshovellers Fracture
Spinous process of C7 vertebrae
Monteggia Fracture Dislocation
Fracture of proximal third of ulna with disolation of proximal radioulnar joint
Galleazzi fracture Dislocation
Fracture of distal third of radius with dislocation of distal radioulnar joint
Colle’s Fracture
Distal metaphyseal fracture of radius with dorsal displacement & angulation
Smith’s fracture (Reverse Colle’s)
Hand and wrist displaced volarly with respect to forearm in distal metaphyseal fracture of radius
Barton’s Fracture
Fracture through the articular surface of distal radius with subluxation of wrist.
Chauffer’s Fracture
Radial styloid fracture
Night Stick Fracture
Isolated fracture of shaft ulna
Bennet’s Fracture Dislocation
Rolando’s Fracture Dislocation
Partial fracture of 1st metacarpal base with trapezium — metacarpal joint dislocation
Comminuted intraarticular (T or V) fractures of base of 1st metacarpal
Pott’s Fracture
Cotton’s Fracture
Pilon Fracture
Bimalleolar (medial & lateral malleolar) fracture. Trimalleolar (medial, lateral & posterior malleolar) fracture. When a large force drives the talus upwards against the tibia 1 plafond, like a pestle (Pilon) being struck into a mortar, causing damage to the articular cartilage & subchondral bone (into several pieces)
March Fracture
Jone’s Fracture
Stress fracture of 2nd metatarsal neck
Fracture of base of 5th metatarsal.
  1. Fracture Talus (Neck)
    1. Talus is the major weight bearing structure (the superior articular surface carries a greater load per unit area than any other bone in body), and it has a vulnerable blood supply and is a common site for post traumatic ischemic necrosis.
    2. The body of talus is supplied mainly by vessels which enter the talar neck from the tarsal canal. In fractures of the talar neck these vessels are divided; if the fracture is displaced the extraoseous plexus too may be damaged and body of talus becomes ischemic.
    3. Fracture of the talar neck is produced by violent hyperextension of ankle. Body of talus fracture is usually a compression injury due to fall from height.
Talus fracture with AVN
  1. Hawkins Classification
    1. Type I Undisplaced
      Treatment- Below knee cast with foot in plantar flexion for 4 weeks.
    2. Type II Displaced associated with dislocation of subtalar joint.
      Treatment- Close/Open reduction & internal fixation
    3. Type III Displaced associated with dislocation at ankle as well as at subtalar joint
      Treatment- Close/Open reduction & internal fixation
    4. Type IV Type 3 + Talonavicular subluxation or dislocation
      Treatment- Close/Open reduction & internal fixation
  2. Complications  
    1. Avascular necrosis of body is a common complication. The incidence varies with the severity of displacement: in type 1 <10%, in type II~40%, in type III >9O
    2. HAWKINS SIGN is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral radiographs.
    3. Malunion predispose to osteoarthritis
    4. Secondary Osteoarthritis of ankle and or subtalar joint occurs some years after injury in over 50% of patients. There are several causes: articular damage due to initial trauma, malunion, distortion of articular surface and AVN. It is most common complication.

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