This team of orthopedic surgeons from the Miller School of Medicine at the University of Miami provide us here with their protocols for better management of common ankle fractures. Although relatively common, the management of an isolated fracture of the malleolus remains indeed a challenge for orthopedic surgeons. In particular, it is a question of determining whether a surgical or non-surgical intervention is indicated, in a personalized way for each patient.
.jpg)
The stability or not of the ankle depends on several factors, the authors remind: especially since no clinical or imaging examination appears to be clearly superior in determining the stability of the ankle after an injury, adds Dr Amiethab A Aiyer, an orthopedic surgeon specializing in foot and ankle care, at Miller School of Medicine. His team sought to convey their experience and available treatment options to clinicians and patients. In particular on the management of isolated lateral malleolus fractures. The malleolus are the bony structures located on each side of the ankle.
- Below the level of syndesmosis: In general, non-surgical treatment is indicated when an ankle is stable after injury. This is particularly the case in the case of a Weber A fracture, a type of ankle fracture characterized by relatively good ankle stability (according to the Danis-Weber classification). Weber A fractures occur below the level of the joint connecting the tibia and fibula bones, also called the level of the syndesmosis.
- When the lesion occurs above the syndesmosis , the fracture, Weber C tends to be more unstable and requires surgery.
- Between the two, a gray area?Indeed, the question arises for Weber B fractures occurring at the level of the syndesmosis. Their management remains much less clear, and this is the subject of this study. The surgeon authors then recommend evaluating the medial space cleared on the radiographs in order to determine the presence of a lesion in the medial flank. In general, a wider gap signals less ankle stability after a fracture. In addition, the authors recommend that clinicians take into account the severity of patients' pain to guide their clinical management. Again, they stress in their press release, “stability is at the heart of the assessment”. But they also recognize that “determining ankle stability after an isolated lateral malleolar fracture remains a diagnostic dilemma”.
It should be noted that the assessment of stability is at the heart of the therapeutic decision but here, dynamic imaging with stress radiographs remains the standard practice for detecting tibio-talar instability. But again, the authors recommend choosing the imaging approach best suited to each patient. Weight-bearing radiographs may vary depending on the weight placed by the clinician, but should incorporate the inherent stability of the ankle in a neutral position. " If the patient is able to put weight on their ankle and there is no radiographic evidence of deltoid involvement, the ankle injury is usually stable and does not require surgery ."
The team will now work on comparing the results obtained with the different technologies available, including the different plate options (thinness, new materials, nailing devices) including the cost/benefit ratio.
.jpg)
