Open trimalleolar fracture of the ankle malaysian orthopaedic. There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. Patients complain of marked pain, swelling, and tenderness associated with an inability to bear weight or ambulate. Feb 07, 2017 bimalleolar and trimalleolar fractures account for more than 30% of all ankle fractures. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks.
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 trimalleolar fracture. Displaced trimalleolar fracture of right lower leg, initial encounter for open fracture type iiia, iiib, or iiic. 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 motor vehicle collision. Management and clinical outcome of trimalleolar fracture of ankle. Over 60% of ankle fractures involve only the lateral malleolus. Ankle fracture belongs to the intraarticular fracture, which can be divided into single ankle fracture, bimalleolar fracture, and trimalleolar fracture tf according to injury mechanism and severity. The posterolateral approach to the posterior malleolus. Fiftyone trimalleolar ankle fractures in 50 patients were evaluated subjectively, objectively, and roentgenographically at an average of 42 months following injury. How much is trimalleolar fracture curable by insertion of. The trauma is sometimes accompanied by ligament damage and dislocation the three aforementioned parts of bone articulate with the talus bone of the foot.
Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures. For left ankle fractures return to driving is generally ok when you are out of the splint, are off of pain medications and have minimal pain in the ankle. The trauma is sometimes accompanied by ligament damage and dislocation. Plain radiograph measurements indicated very poor inter and intraexaminer reliability. Mar 22, 2011 the evaluation of trimalleolar fracture pain and suffering cases has come before our appellate courts with some frequency and weve discussed them before, for example, here and here. Posterior malleolus fractures in trimalleolar ankle fractures ncbi. Ligaments stabilising the ankle joint the anterior talo fibular ligament t he calcaneo fibular ligament the posterior talo fibular ligament the deltoid ligament 2. Follow these steps to quickly combine and arrange documents. 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. Trimalleolar fracture complications things you didnt know. Diagnosis of trimalleolar fracture doctor answers on. The majority of patients were white, female, and younger than 50 years old. Placing a value upon traumatic trimalleolar ankle fractures.
The limited visualization of the posterior malleolar fragment afforded by this exposure has led other authors to describe different techniques to facilitate anatomical reduction. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. This may need surgery but it depends on your orthopedic surgeon as to whats the best course for you. 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.
A trimalleolar fracture involves the lateral and medial malleolus in addition to the distal posterior tibia, which is the posterior malleolus. This type of fracture commonly mandates open reduction surgery often requiring the insertion of plates, screws and kwires. Open trimalleolar fractures dislocation is not common and usually. Open reduction and internal fixation of a trimalleolar ankle. Available in high resolution jpeg or pdf formats, 8x10 print, or laminated foam core exhibit board 24x46, 30x40 or 36x48.
Functional outcome and limitation of sporting activities. Trimalleolar fracture is a specific injury in the ankle, where three areas known as the malleoli break simultaneously. These results demonstrate that posterior malleolar fracture fixation is closely related to successful radiological and functional outcomes after trimalleolar fractures. This is usually a very unstable fracture and typically requires surgical intervention because there is no lateral support to the ankle. The injury may also involve the deltoid ligament medially or the syndesmotic ligaments laterally. Trimalleolar fracture of the left ankle by katie clarke on prezi. I was diagnosed with a trimalleolar fracture and put in a cast to reduce the swelling until i am ready for surgery on friday. Twentyfive patients with trimalleolar ankle fractures were evaluated using both conventional radiography and computed tomography ct to determine the size of the posterior fragment along with other fracture characteristics.
I am experiencing a burning sensation at the back of my heel under my cast. Luks on how much is trimalleolar fracture curable by insertion of metal plates and screws. The severity of the ankle fracture was defined as a single lateral malleolar fracture, bimalleolar, and trimalleolar fracture. Posterior malleolar fractures of the ankle article pdf available in european journal of trauma and emergency surgery 416 august 2015 with 5,710 reads how we measure reads. Additionally, a trimalleolar fracture may be further complicated by a bone infection, nerve or blood vessel damage, and arthritis. A free and open source software to merge, split, rotate and extract pages from pdf files. Treatment of bimalleolar and trimalleolar fractures these fractures are unstable by nature and need to be repaired using open reduction and internal fixation in the operation room. Deze gratis online tool maakt het mogelijk om meerdere pdf bestanden of afbeeldingen te combineren in een pdf document. How to determine the reasonable settlement value of traumatic.
Apr 23, 20 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 fractures involve the medial malleolus, the posterior aspect of the tibial plafond referred to as the posterior malleolus and the lateral malleolus. Do you want to join multiple pdf documents into a single pdf document. Ligaments of the upper ankle the anterior inferior tibiofibular ligament the interosseous. It is most always a devastating, debilitating and life altering injury. A trimalleolar fracture is a threepart break of the ankle. My recovery from a trimalleolar ankle fracture compleat fitness. The only difference between the two fractures is the need for fixation of the posterior malleolus or the posterior aspect of the tibial joint. Symptoms of trimalleolar fracture doctor answers on.
Hopkins appears to be at the higher end of typical trimalleolar cases resolved on appeal in view of the following recent decisions. Pdf management of trimalleolar fracture in sanglah. This unstable fracture warrants a prompt diagnosis and urgent surgery. Im on workers comp for a trimalleolar fracture of the left ankle i have a plate n screws the workers comp doc has me at 33% mild to moderate partial would i still get a settlement if so about how much. Trimalleolar ankle fracture dislocation treatment using plate and screw fixation. Plain radiographic interpretation in trimalleolar ankle frac. Ankle trimalleolar fracture orif operative sample report. Im on workers comp for a trimalleolar fracture of the left. The incidence of ankle fractures in the adult population is dependent upon multiple factors, including age, sex, specific sport, and competitive level in athletics. The biomechanics of the subtalar joint are such that violent inversion supination of the hindfoot produces external rotation of the talus, causing a fracture of the. Recovery from a trimalleolar ankle fracture may be long and difficult, as this type of injury is considered severe.
The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood now. Nondisplaced trimalleolar fracture of right lower leg, subsequent encounter for open fracture type iiia, iiib, or iiic with routine healing. Trimalleolar fractures refer to a threepart fracture of the ankle. The mechanism of injury is direct impact caused by inversion or eversion injuries. The patient is a xxyearold male who twisted his left ankle sustaining a trimalleolar ankle fracture dislocation. Trimalleolar fractures are one of the most complex fracture around ankle. Doctor answers on symptoms, diagnosis, treatment, and more. Trimalleolar fracture definition of trimalleolar fracture. 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. Pdf download for management and clinical outcome of trimalleolar. Samenvoegen en downloaden en weergeven biedt een eenvoudige manier om pdfbestanden te combineren. Assistant surgeon, cumberland hospital brooklyn, new york trimalleolar fracture, so more satisfactory, because the pathological named by henderson. It should be assessed with a detailed history and physical exam as well as imaging studies.
Mathes ankle fractures breaks are very common injuries that usually happen from a fall where the ankle is twisted or rolled or there is high. The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade. Doctors will often treat this type of fracture with surgery. Severe situation can accompany with the dislocation and the rupture of inferior tibiofibular syndesmosis. The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. Dislocations were more likely to result from trimalleolar fractures p trimalleolar fractures p trimalleolar fractures are one of the most serious types of ankle fractures. Listing a study does not mean it has been evaluated by the u. Technique surgery is performed in the prone position with a bump under the. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 april 2015 v1s. Management of the posterior malleolus in trimalleolar fractures.
Adult ankle fractures ankle and foot soft tissue injuries. Functional outcome and limitation of sporting activities after bimalleolar and trimalleolar ankle fractures. Problems associated with ankle fractures after surgery. Trimalleolar fracture and repair high impact visual. Ankle joint dislocation treating dislocated trimalleolar. In this study, 16 per cent of the fractures were lateral malleolar, 45 per cent were bimalleolar, and 39 per cent were trimalleolar. Trimalleolar fracture is defined as fracture of the medial and lateral malleoli and the posterior tip of the tibia. The posterolateral approach has been described in the litera ture but has not received much attention. Unimalleolar versus bimalleolar fixation in bi or trimalleolar ankle fracture the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. 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.
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