Dr. Ebraheim animated educational video describing current concepts of foot and ankle injuries.
I.Ankle fractures
a.Supination-external rotation
i.Vertical fractures of medial malleolus is bad
ii.Differentiate between supination/external rotation and pronation/external rotation by lateral x-ray to see the direction of the fracture
b.Isolated lateral malleolar fracture
i.Nondisplaced with no talar shift can be treated conservatively.
ii.Displaced fracture with talar shift will require surgery.
c.Weber C fractures
i.Syndesmotic injuries are common
II.Ankle fractures & diabetes
a.Surgery is better in diabetics
III.Pilon fracture (tibial plafond)
a.Axial load, high energy injury. Can occur due to a fall or from a car accident.
i.medial malleolar fragment
ii.Anterolateral fragment: chaput fracture
iii.Posterolateral fragment: Volkman fracture (posterior inferior tibiofibular ligament is attached to this fragment)
IV.Treatment of displaced fractures:
a.Delay open reduction internal fixation until the skin condition improves.
b.Soft tissue complications: you need to get skin wrinkles before you do internal fixation.
c.Joint fusion surgery (arthrodesis) for arthritis: not commonly used or needed.
V.Navicular fractures
a.Stress fracture of the navicular is the important one and usually occurs in the central third.
b.Treatment: Cast and non-weight bearing. Do ORIF in athletes, if there is a nonunion, or failure of conservative treatment and also in displaced fractures of the navicular.
VI.5th metatarsal base fractures
a.Zone I: proximal tubercle avulsion fracture. Treatment of zone I proximal tubercle fracture Is usually nonoperative (use a boot or a fracture shoe).
b.Zone II (jones fracture) at the 4th and 5th metatarsal articulation which is the junction between the metaphysis and the diaphysis.
c.Zone III proximal diaphysis fracture
VII. Open calcaneal fractures
a.Open fractures of the calcaneus may lead to amputation. There are two basic fragments:
i.anteromedial (sustentacular) fragment
ii.posterolateral (tuberosity) fragment
VIII.Talus fractures (Hawkin’s classification)
a.Type I: non-displaced. 10% AVN
b.Type II: fracture with subtalar dislocation or subluxation. 50% AVN.
c.Type III: fracture with subtalar and tibiotalar subluxation or dislocation. 90% AVN.
d.Type IV: fracture with subtalar and tibiotalar dislocation and talonavicular subluxation. 90-100% AVN.
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