Ankle Fractures , Special Situations - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing fractures special situations, describing fractures of the ankle X – rays and ankle fracture classification, ankle fracture dislocation .
It also describes ankle fracture treatment and ankle fracture surgery and ankle fracture recovery
Ankle fractures and driving:
Normal base line breaking time is about 9 weeks after surgery.
For total hip is about 6 weeks.
For long bone and periarticular fractures of the lower extremity, the breaking time is significantly reduced up to 6 weeks after initiation of weight bearing.
Diabetes: in patients with diabetes, the first thing we have to check is if the patient have peripheral neuropathy, or Charcot- fracture.
Diabetic patient has also high risk of infection, hardware failure, and delayed healing; the bone takes more time to heal.
You have to do more percutaneous fixation, a lot of screws from the fibula to the tibia; it gives you more strength of the fixation because the screws are engaged into the tibia, so they are stronger than the small little screws in the fibula.
Then delay weight bearing time and half more than the normal so usually you delay the weight bearing for about 3 months.
Remember: surgery in displaced fracture in the ankle in diabetics is better than no surgery, but the complication rate is high.
Ankle malunion:
Usually the fibula is short and malreduced, and the syndesmosis is disrupted, usually you correct that by corrective osteotomy of the fibula to restore the fibular length, alignment, and rotation.
You have to do anatomic reduction of the fibula and the Mortise, you have to do the plating of the fibula, and bone graft if needed, in addition to syndesmotic reconstruction.
And you do ankle reconstruction to prevent arthritis by reducing the talus to the ankle mortise.
Fibular fracture and unstable ankle mortise will allow the talar shift.
1mm shift of the talus will decrease the tibiotalar contact area by 42%.
What are the fracture variants?
- Maisonneuve fracture: it is a fracture of the proximal fibula with syndesmodic disruption, you can miss this fracture because you may think the patient has an ankle sprain, especially if the injury of the deltoid ligament is not apparent on the x-ray, you probably need to get long leg films to diagnose the fracture.
So you need to fix the syndesmosis because in these patients the syndesmosis is disrupted, so you need to restore the fibular length and alignment before the insertion of the syndesmotic screws.
Accurate reduction of the syndesmosis is needed.
- Volkmann fracture: it is a fracture of the posterolateral aspect of the tibial attachment of the posterior inferior tibiofibular ligament.
- Tillaux fracture: it is a salter type III fracture, it is a fracture of the tibial attachment of the anterior inferior tibiofibular ligament in the young.
- Wagstaffe’s fracture: it is a fracture of the medial part of the fibula with that part being avulsed at the insertion of the anterior- inferior tibiofibular ligament.
The anterior- inferior tibulofibular ligament remains intact.
- Chaput’s Tubercle fracture: it is a fracture of the anterolateral part of the tibia in adults.
It is similar to Tillaux fracture.
Chaput’s tubercle fracture is different from Chaput’s fracture which is mid tarsal joint injury.

So the ligament remains intact with:
- Tillaux fracture
- Wagstaffe’s fracture
- Chaput’s Tubercle fracture

The ligament is avulsed from the tibia in:
- Tillaux fracture in the young
- Chaput’s Tubercle fracture in adults

The ligament is avulsed from the fibula in:
- Wagstaffe’s fracture
Bosworth fracture dislocation: rare fracture of the ankle, the fibula become trapped behind the tibia and become irreducible.
The posterolateral ridge of the distal tibia will block reduction of the fibula.
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