9 Using the OA/OTA fracture classification, type B fractures comprise the greatest percentage of ankle fractures, followed by Type A and Type C. ![]() 1 Traumatic medial malleolar fractures have the highest proportion of open injuries. ![]() 41 Amongst ankle fractures, unimalleolar injuries occur most commonly (60-70% lateral > medial), 41 followed by bimalleolar (15-20%), and trimalleolar (7-12%) respectively. 41,42 Female incidence increases between the ages of 30-39 and 60-69, while the male incidence either follows a more uniform distribution 42 or decline after the age of 20. 5 Mean patient age, depending on the study, ranges from the 40’s to 50’s, with an overall female predominance. 7 The incidence in the adult population is dependent upon multiple factors, including age, sex, specific sport, and competitive level in athletics. EpidemiologyĪnkle fractures account for 9.3% of all fractures, 6 over 50% of traumatic foot and ankle fractures, 9 and are the 4 th most common fracture in the elderly. 4 Additional classification systems include Danis-Weber and OA/OTA (please see supplemental assessment). 3 Similarly, a recent small study found that the mechanisms proposed by Lauge-Hansen were only 58% accurate in predicting actual fracture patterns. 2 However, one report found that nearly 53% of the ankle injuries studied did not coincide with the predicted injury pattern based on mechanism of injury, and that 14% had a common fracture pattern not explained by the various combination of forces proposed by Lauge-Hansen. The Lauge-Hansen classification system for ankle fractures attempts to link mechanism of injury and fracture pattern. 1 However, the exact combination of forces that produce a particular pattern of fracture is still not clear. Such movements almost always include inversion or eversion. EtiologyĪnkle fractures typically result from a sudden, forceful twisting movement in multiple planes. Pediatric ankle fractures typically involve the physis and are not within the scope of this article. Information on ligament injuries and ankle sprains may be found in “ Ankle Sprain”. Information on foot and ankle stress fractures and other overuse injuries can be found in “ Ankle and Foot Overuse Disorders”. This article will focus strictly on fractures of distal tibia and fibula in the adult patient. After the test, radiographs were taken and interpreted by the attending orthopaedic physician to confirm or rule out the presence of a fracture.Ankle fractures refer to any fracture involving the bones of the talocrural joint, namely the distal aspects of the tibia and fibula, and the talus. Diminished or absent sound from the injured limb as compared with the uninjured limb constituted a positive result. For example, if the fibula was the injured bone, the vibrating tuning fork was placed on the distal tip of the lateral malleolus and the stethoscope's conical bell was placed on the fibular head ( Figure). I listened for a clear tone created by the tuning fork in the uninjured bone and compared it with the sound arising from the injured bone. I then listened to the sound arising from the bone via the stethoscope for approximately 6 to 8 seconds. ![]() I struck the tuning fork against a rubber pad and then placed the vibrating tuning fork on the bone distal to the injury site. The tuning fork was placed on the bone distal to the suspected fracture, and the stethoscope's conical bell was placed proximal to the injury site on the same bone. ![]() The test was performed on the uninjured limb first. The procedure was conducted as described by Misurya et al, 6 except that the conical bell of a stethoscope was used instead of a pediatric stethoscope. The author administered the tuning fork test to all participants.
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