It was originally described by Christian Lauge-Hansen, a Danish pathologist in 1950 and later copied by Bernhard Georg Weber in 1972, a member of the AO-group. No other fracture was seen. Osteoarthritis can occur secondary to persistent joint incongruity. The ankle is a ring structure consisting of the tibia, fibula and the talus. (c) AP radiograph obtained after reduction and internal fixation shows restored ankle alignment and placement of a pin to repair the distal fibular physeal fracture. Any pain or soft tissue swelling on the medial side can be a first indication that we are dealing with a Weber C fracture. Postreduction radiographs are useful for assessing the adequacy of alignment and physeal reduction. Several systems for classifying calcaneal fractures exist (Fig 16). Figure 22b. Closed reduction should be attempted for displaced fractures. There was no associated fibular fracture. More complicated than the Weber classification. Primary tibial and fibular ossification is present at birth (11). Here a typical avulsion or pull-off fracture of the lateral malleolus.The avulsion fragment is quite large. Although supplemental radiographic views have been described (62), the widespread availability of CT has diminished the applicability of these images. Figure 6. 4, International Journal of Emergency Medicine, Vol. Drawing illustrates the Salter-Harris classification of growth plate fractures at the distal tibia. Hindle et al (45) examined 71 patients with ankle dislocations, four of whom did not show evidence of concomitant ankle fracture. The leg grows approximately 34 mm per year during childhood, with the distal tibial physis accounting for 40% of the growth of the tibia and for 17% of the overall growth of the lower extremities. The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The direction of force rotates around the ankle. Tiny bone avulsed fracture from the distal fibula and an anatomical variant, os subfibulare. A displaced ankle fracture is where the broken bone fragments are separated. The combination of fracture and ligament damage complicates assessment, as ligament damage is not directly visible on x-ray. Salter-Harris Classification of Physeal Fractures.The most simple and commonly used anatomic classification system for pediatric physeal fractures (12,23,24) is the Salter-Harris system (Table 2, Fig 4) (25). (c) Mortise radiograph of the ankle in a 17-year-old boy shows a further decreased medial clear space (black arrow), developing tibiofibular overlap (single-headed white arrow), and a further increased fibular width (double-headed arrow). Set by the GDPR Cookie Consent plugin, this cookie is used to store the user consent for cookies in the category "Others". A sagittally oriented apophysis (white arrow) at the base of the fifth MT bone also is seen. Figure 19b. Follow-up AP radiograph of the foot obtained a few weeks after the initial injury shows nonspecific sclerosis (arrow) at the distal aspect of the cuboid bone, compatible with a healing toddler fracture. (b) AP radiograph of the right foot in an 8-year-old girl shows contiguous MT fractures: a nondisplaced second MT bone fracture (arrow) and displaced slightly comminuted third and fourth MT bone fractures (arrowheads). Just like a Weber C fracture it is the result of an exorotation force applied by the Compared with adults who have calcaneal fractures, children with these injuries have a higher proportion of extra-articular fractures and a better prognosis. Impaction injuries can give rise to radiographically occult osteochondral fractures of the talar dome (61). Knijnenberg et al (69) found that the distances between the first and second MT bases measured on AP radiographs obtained in skeletally healthy pediatric patients were consistently shorter than 3 mm. 29, No. These fractures represent 5%10% of pediatric intra-articular ankle injuries (37). Fractures of the posterior tibial tubercle should not be confused with fractures of the posterior articular margin (posterior malleolus), which have a worse prognosis. Variable ossification of the navicular bone may be mistaken for Khler disease (33). Three standard (AP, oblique, and lateral) radiographic views are usually adequate for the detection of fifth MT fractures. X-ray. On radiographs, a bony bar at the physis (Fig 23) or asymmetric Park-Harris growth arrest lines may be seen. A weber B fracture is oblique and more vertical because it is a push-off fracture, which we will discuss later. The keystone wedging of the second MT bone into the medial cuneiform bone supports the entire tarsometatarsal articulation. Figure 21. There is also a tertius fracture (stage III). A Salter-Harris type IV fracture extends from the metaphysis to the epiphysis. This tarsal bone complex is restrained by a network of ligaments, capsules, and fasciae. However when there is also a vertical or push-off fracture of the medial malleolus, then it is stage 2 and the ankle is unstable, as the ring of stability is broken in two places. Figure 20a. There is no associated syndesmotic widening. Population-based studies suggest that the incidence of ankle fractures has increased dramatically since the early 1960s. Tibiotalar dislocation in a 14-year-old girl that occurred after a trampoline injury. Fracture mimics. Up to 22% of all MT fractures involve the base of the MT bone, and 90% of these injuries occur in children older than 10 years (33). Supination-exorotation Mechanism (fig. AP radiograph of the left ankle shows a distal tibial Salter-Harris type II fracture with a laterally based metaphyseal Thurston-Holland fragment. These fractures result from forced dorsiflexion with an axial load after high-energy trauma. It can occur at numerous sites in the body, but some areas are more sensitive to these types of fractures than others, such as at the ankle which mostly occurs at the lateral aspect of the medial malleolus or in the foot where avulsion fractures are common at the base of the fifth metatarsal, but also at the talus and calcaneus. There is no associated syndesmotic widening. (a) AP radiograph of the ankle shows a medially displaced talar neck fracture (arrow). CT may aid in preoperative planning (70), but it cannot be used to determine instability. Calcaneal fractures observed on CT images have been divided into intra- and extra-articular fractures on the basis of the involvement of the posterior facet of the subtalar joint (Fig 15) (48). A conservative approach involves appropriate immobilization and protected weight bearing, with serial follow-up radiographs obtained to exclude late displacement in the cast. Oblique. Avulsion Fracture of the Lateral Ankle Ligament Complex in Severe Inversion Injury: Incidence and Clinical Outcome. MT fractures. In this lecture we present a simple algoritm that helps you to find: The algoritm is based on the Weber-classification, because it is simple and everybody knows it. Early-manifesting complications of foot and ankle fractures include infection, neurovascular injuries, compartment and extensor retinaculum syndromes, complications of cast placement, and reflex sympathetic dystrophy and/or complex regional pain syndrome (9). The patients skeletal maturity must be considered in treatment decisions. Associated neurovascular compromise may be present. When the x-rays of the ankle show no obvious fracture like a Weber A or B, then the question is: could this be a Weber C fracture? (b) Accompanying lateral radiograph shows the dislocation at the tibiotalar joint to be posterior. Drawings illustrate the triplane fracture types described by Rapariz et al (39). Fracture mimics. Ischemia can involve only part of the talar dome, usually the medial aspect, and result in a partial Hawkins sign, usually of the lateral talar dome. There may be overlap in the fracture types, and treatments should be individualized to specific patients. (a) Mortise radiograph of the ankle in a 2-year-old boy shows a wide medial clear space (black arrow), prominent tibiofibular interval (single-headed white arrow), and small relative fibular width (double-headed arrow). trimalleolar fractures occurring in the remaining 5% to 10%. Figure 16. Extensor retinaculum syndrome usually involves the anterior metaphyseal spike of a triplane fracture compressing the extensor hallucis and peroneus tertius muscle bellies and the deep peroneal nerve against the rigid superior extensor retinaculum. Necessary cookies are absolutely necessary for the website to function properly. Note the widened medial clear space (red arrow); rupture of medial collateral ligaments. Swelling and ecchymosis over the cuboid should raise suspicion of this injury and when other midfoot injuries are present , the cuboid articulations should be carefully inspected for subtle injury. MRI can be performed to assess the integrity of the Lisfranc ligament. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously. Table 3: Dias-Tachdjian Classification of Physeal Ankle Fractures. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Babu V, Feger J, Feger J, et al. 1. On the enlarge view we also recognize a small avulsion fracture. The navicular bone ossifies between the ages of 2 and 4 years and may have multiple ossification centers. Injury mechanisms include stubbing or kicking injuries, dropped objects falling on the toe(s), and falls from a height. (b) AP postoperative radiograph shows first and second tarsometatarsal arthrodesis and an oblique screw transfixing the Lisfranc joint from the medial cuneiform bone to the base of the second MT bone. An approach to reading an ankle radiograph can be read here. Figure 15b. Bernhard Georg Weber. (a) Lateral radiograph of the ankle of a 14-year-old boy after a twisting injury to the right ankle shows a subtly widened anterior physis at the distal tibia with a posteriorly based Thurston-Holland fragment (arrow). Figure 14a. Trauma mechanism of supination-adduction according to Lauge-Hansen. This is always stage 2 and unstable. Coronal reformatted CT image shows a distal tibial fracture (single-headed arrow). It was determined that the occurrence of these mechanisms always follows a uniform order. Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior tibiofibular ligament fails There may be extremely subtle sclerosis or no visible abnormality at radiography, and, thus, MRI may be required (Fig 19). The highest incidence of ankle fractures occurs in elderly women. In the Bozic et al study (15), the incisura fibularis appeared at a mean age of approximately 8 years in girls and approximately 11 years in boys. As the exorotation of the foot continues the distal fibula follows this exorotation movement, while the proximal fibula is held in position at the proximal tibiofibular joint and you get a twist-like fracture somewhere above the level of the syndesmosis (stage 3). The Lisfranc joint is the articulation of the tarsus with the MT bases. Furthermore, the ossicle may cause limitation of the range of motion of the ankle joint resembling avulsion fractures of the lateral malleolus. Another important thing to realize is that traction on a ligament results in either a rupture or an avulsion. Findings on standard nonweight-bearing radiographs of the foot (not shown) were unremarkable. Intra-articular injuries increase the risk of subsequent arthritis sevenfold (84). During healing of physeal fractures, the orientation of the growth arrest lines, also known as Park-Harris lines, should be carefully scrutinized. In a retrospective review (26) of 725 tibial fractures in children, 31.0% of the cases involved the distal tibial physis, and the majority (56.9%) of these were cases of Salter-Harris type II fracture, 21.7% were cases of Salter-Harris type III fracture, and 20% were cases of Salter-Harris type IV fracture. In view of the widened medial clear space, this is a rupture of the medial collateral ligaments (stage IV). We, and third parties, use cookies on our website. The two differences between Weber B and C are: Sometimes we are lucky, because the fibula fracture is visible on the x-rays of the ankle.Then we know we are looking at an unstable stage 3 weber C fracture. Lateral ankle injuries are extremely common, most commonly injury to anterior talofibular (ATFL)and calcaneofibular ligaments (CFL). Now we recognize the soft tissue swelling on the medial side, which is stage 1. Lisfranc injury in a 17-year-old high school football player, which occurred after another player fell on the back of his heel, causing hyperflexion of his midfoot. The damage starts at the medial side, turns anteriorly along the ankle to lateral, ending at the posterior side. Toddlers with calcaneal stress fractures who are just learning to walk refuse to bear weight. Q: What is the name of this accessory bone? (a) Coronal fluid-sensitive MR image of the foot shows diffusely high signal intensity (arrow) throughout the navicular bone. A Salter-Harris type I physeal fracture passes along the width of the physis and may be visible at radiography if the growth plate is widened or the epiphyseal and metaphyseal components are malaligned. The supination-inversion mechanism (Fig 7) is the most common Dias-Tachdjian ankle fracture pattern (33). Eismann et al (42) advocated the use of CT as an adjunct to radiography for triplane fracture classification, displacement identification, and treatment planning. Open fractures have an overall higher propensity for the development of infection (Fig 24). (b) Findings on the sagittal CT image of the left ankle confirm partial physeal fusion at the distal tibia (arrows). First Question: Is it a Weber A, B or could it be a Weber C? Midfoot and hindfoot fractures generally involve greater force, such as that from a fall from a height or from a higher-speed mechanismfor example, a bicycle or motor vehicle accident. Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, All ankle fractures, even the ones that are not visible on the X-rays, Predict rupture of ligaments even if you cant see them on the images, Determine whether the ankle is stable or unstable, just by looking at the radiographs. Figure 13b. Ankle extensor retinaculum and lateral ligaments injuries - ultrasound, avulsion fracture of the anterior calcaneal process. Limping or an inability to walk, if the broken bone is 27, No. (b) Accompanying lateral radiograph shows the dislocation at the tibiotalar joint to be posterior. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Anterior process fractures are classified into three types: type 1 fractures are small (< 1 cm) and nondisplaced, type 2 fractures have minimal (> 2 mm) displacement and no involvement of Calcaneal Fractures.Five percent of all calcaneal fractures occur during childhood. In a relatively recent study (67) of the MRI appearances of pediatric cuboid fractures, the fractures were found to occur in isolation, linear, and most commonly adjacent to the tarsometatarsal joint. This is a stage 1 stable Weber A fracture. Salter-Harris type V injuries are rare or at least tend not to be diagnosed acutely. Many avulsion fractures are apparent of plain radiographs. Since the fibula fracture in a Weber C is most commonly not visible on the x-rays of the ankle, this can be a tough question to answer.We will have to look for additional findings that lead us to the right answer and that will help us to make the decision to do additional images. The exorotation movement of the talus will cause the (fixated) lateral malleolus to break. The Open physes protect against ligamentous and syndesmotic injuries (18). Treatment strategies, whether conservative or surgical, are aimed at restoring articular congruency and functional alignment and, for pediatric patients specifically, protecting the physis. Anatomic variants and developmental phenomena can mimic or obscure the diagnosis of osseous and ligamentous trauma in skeletally immature patients (Fig 25). Is there an avulsion of the lateral malleolus. In addition, they may be open or closed. The variably sized tibial Thurston-Holland fragment has a predominantly posterior location. Figure 19a. 2, Radiologic Clinics of North America, Vol. The supinationexternal rotation (Fig 8) mechanism first results in a physeal fracture of the distal tibia, with a large and medially to posteromedially based Thurston-Holland fragment. With this classification, each injury type is assigned a prognostic significance. The ankle transfers force between the foot and the rest of the axial skeleton, enabling stability and foot movement (7). stage 4 is injury to the posterior syndesmosis, which sometimes can not be seen, but will be suspected if there is a widening of the ankle fork or when there is an avulsion of the malleolus tertius like we see in the illustration. The supination-inversion (SI), supinationexternal rotation (SER), pronationexternal rotation (PER), and supinationplantar flexion (SPF) mechanisms of injury are depicted. You have sustained an avulsion fracture to your ankle, which is treated like a soft tissue injury (sprain) to your ankle. CT is useful for assessment of comminuted fractures and small fractures of the anterior process, and for surgical planning. Set by the GDPR Cookie Consent plugin, this cookie is used to record the user consent for the cookies in the "Necessary" category . These fractures traditionally have been characterized on the basis of the number of fragments, with two-, three-, and four-part triplane fractures described (3841). This is a normal developmental variant; there is no associated soft-tissue swelling. They have a bimodal presentation, involving young males and older females. The syndesmosis consists of the anterior/posterior tibiofibular ligament and the interosseous ligament (fig. The normal anatomy of the distal tibia (A), as well as type I (B), type II (C), type III (D), type IV (E), and type V (F) Salter-Harris fractures, are depicted. No other fractures were seen. Osteonecrosis appears radiographically as talar dome sclerosis, and it usually develops a few weeks to 6 months after the fracture manifests (33). An associated spiral fracture of the fibular shaft (arrowhead) also is present. Keep in mind that a tertius fracture can be stage III, and that damage may be more extensive than initially visible on the image, Indications/Requests for Radiological Examination. Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest, Centers for Disease Control and Prevention, Factors that Increase Risk of Getting Arthritis. AP (a) and lateral (b) ankle image. Table 6: Fractures Amenable to Conservative Treatment, Table 7: Indications for Surgical Management of Fractures. Posttraumatic avascular necrosis can complicate certain fracture types, fifth MT proximal shaft fractures (ie, Jones fractures) and talar neck fractures in particular. By clicking 'Accept and continue' you agree to the use of all cookies as described in our. Just by looking at the images, you can understand the trauma mechanism (scroll). (b) Accompanying lateral radiograph also depicts the talar neck fracture. Figure 5. Injury mechanisms include load toward the heel, shear force across the midfoot, and/or twisting injury. The talus will continue to exorotate and will no longer be checked by the medial ligaments, causing the talus to push away the fibula. II. Developing apophysesfor example, those developing at the fifth MT basecan be mistaken for avulsion fractures. And just like in a Weber B, you can get injury to the anterior syndesmosis, fibula and finally the posterior syndesmosis. The fracture line of the distal fibula continues to the level of the horizontal tibiotalar joint (stage II). Due to the pronation there is enormous stress on the medial collateral bands and thats where the injury will start with either a band rupture or an avulsion of the medial malleolus (stage 1). Skin tenting signifies soft-tissue injury. For instance a tertius fracture is either stage 3 in a Weber B or a stage 4 in Weber C fracture. The associated fracture of the distal fibular shaft (arrow) does not involve the fibular physis. The precarious blood supply of the talus makes this bone vulnerable to osteonecrosis (61), the risk of which correlates strongly with the Hawkins-Canale classification (6163). Figure 15a. (b) AP radiograph obtained after open reduction and internal fixation with cancellous screw placement across the distal tibia shows a reduced intra-articular gap (arrow). An associated complete fracture through the distal fibula (*), with medial displacement of the detached distal fibular epiphysis, also is present. Lateral Ankle Sprain may be associated with: ankle dislocation, distal lateral malleolar avulsion or spiral fracture, medial malleolar fracture, talar neck or medial compression fractures. In children, snowboarding has been found to be associated with lateral talar process fractures, which are rare (59,60). Ankle Avulsion Fracture. A subgroup of pediatric ankle fractures called transitional fractures occur during the 18-month developmental window (in girls aged 1215 years and boys aged 1418 years) The systems used to classify clinically important fractures, including the Salter-Harris, Dias-Tachdjian, Rapariz, and Hawkins systems, are described, with illustrations that reinforce key concepts. Oblique radiograph of the right foot shows a subtle transversely oriented fracture lucency (black arrows) at the base of the right fifth MT bone, signifying a nondisplaced fracture. Frontal. (a) AP radiograph of the right foot in a 1-year-old girl who fell while being carried down the stairs shows a fracture (arrow) at the base of the first MT bone. Combined experimental-surgical and experimental-roentgenologic investigations, Physeal injuries of the ankle in children: classification, Surgically Relevant Patterns in Triplane Fractures: A Mapping Study, The pediatric triplane ankle fracture, The triplane fracture: four years of follow-up of 21 cases and review of the literature, Distal tibial triplane fractures: long-term follow-up, Tibial fractures involving the ankle in children: the so-called triplane epiphyseal fracture, Epiphyseal fractures of the distal ends of the tibia and fibula: a retrospective study of two hundred and thirty-seven cases in children, Pediatric Triplane Ankle Fractures: Impact of Radiographs and Computed Tomography on Fracture Classification and Treatment Planning, Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study, Long-term result of a pure tibiotalar dislocation in a child, Appendicular joint dislocations, Upward tibiotalar dislocation without fracture: a case report, Dislocations and fractures of the talus, Multidetector CT evaluation of calcaneal fractures, Calcaneal fractures in children: an evaluation of the nature of the injury in 56 children, Fractures of the os calcis in children, Calcaneus fracture in the child, The mechanism, reduction technique, and results in fractures of the os calcis, Skeletal injury in the child, Fractures of the Os Calcis: A Long-Term Follow-up Study of 146 Patients, Operative treatment in 120 displaced intraarticular calcaneal fractures: results using a prognostic computed tomography scan classification, Complications of talus fractures in children, Fractures of the neck of the talus. They are connected by 3 ligaments (the medial/lateral collateral ligaments and the interosseous ligament). Figure 1. Enter your email address below and we will send you the reset instructions. Navicular Fractures.Navicular bone fractures are often missed. The midfoot consists of five tarsal bones and their articulations. Weber B is the most common ankle fracture accounting for 60-70% of all ankle fractures. These classification systems aid in diagnosis and treatment planning, facilitate communication, and help standardize documentation and research. This phenomenon most commonly occurs when anatomic reduction has not been achieved, an interfragmentary gap is larger than 3 mm, or an articular cartilage injury has occurred. Since this fracture is usually not visible on x-rays of the ankle, you wanna study the ankle x-rays to look for stage 1 and 4, which can be a clue to image the whole lower leg to look for a high fibula fracture. Most (86%) ankle ligament tears are midsubstance; thus, only 14% are avulsion injuries. Oblique fibula fracture at level of syndesmosis. MT Fractures.MT fractures are common. References Ng J, Rosenberg Z, Figure 20b. No other fractures were seen. (c) Mortise radiograph of the ankle in a 17-year-old boy shows a further decreased medial clear space (black arrow), developing tibiofibular overlap (single-headed white arrow), and a further increased fibular width (double-headed arrow). In Weber B there is a oblique oriented push-oof fracture at the level of the syndesmosis, while in Weber C there is a twist-like fracture above the level of the syndesmosis. Radiographics. Clin Orthop Relat Res. Figure 23. Acta Orthop Scand. The ankle forte is unstable and the distal fibular fracture is fixated using plate osteosynthesis (fig. Describes the mechanism of the ankle fracture and is subdivided into 3 groups (supination-adduction, supination-exorotation and pronation-exorotation). Coronal CT image of the left ankle shows a distal fibular Salter-Harris type I fracture with displacement of the distal fibular epiphysis (*). {"url":"/signup-modal-props.json?lang=gb\u0026email="}, Patel M, Ankle extensor retinaculum and lateral ligaments injuries - ultrasound. The most common navicular fractures are fractures of the navicular tuberosity, dorsal cortical avulsion, and stress fracture. Talar neck fractures are much more common than talar body fractures, which, in turn, are more common than lateral and posterior process fractures. I. In the axial plane you can see that the injury starts on the medial side due to the pronation of the foot and follows a clockwise rotation through anterior and lateral to posterior. There may be an accompanying fibular fracture that does not involve the physis (33). High twist-like fibula fracture above the level of the syndesmosis. The ankle is a synovial hinge joint that comprises the tibia and fibula, which articulate around the central talus; this complex is referred to as the ankle mortise (8). (b) Volume-rendered CT image in a different patient with a similar injury pattern more clearly depicts a posterior fracture fragment. Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior tibiofibular ligament fails to tear during an injury. In addition, the distance between the medial cuneiform bone and base of the second MT bone has been found to be larger in individuals younger than 6 years (70). The Chopart joint allows the hindfoot to pivot while the forefoot remains stationary (10), acting together with the subtalar joint to facilitate foot inversion and eversion. Often they are seen in only one of the frontal or oblique views. Figure 7. L = left. Hawkins type II displaced talar neck fracture in a 15-year-old girl with left ankle deformity, ecchymosis, and swelling after she fell from an aerial cheerleading spin and landed on her left leg. Drawing illustrates the Dias-Tachdjian classification of growth plate fractures at the ankle. 2018;32(1):S1-S10. Triplane fractures occur during the early phases of physeal closure, and juvenile Tillaux fractures occur when physeal fusion is almost complete; therefore, neither of these transitional tear types is complicated by significant physeal arrest. Both the tibiofibular overlap on AP and mortise views and the relative fibular width on AP views increase with age. In many cases however, the fibula fracture is higher up and we need additional x-rays to find the fracture. You can look at the next images for a discussion of the images. 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( 61 ) a ligament results in either a rupture or an inability to walk, the. Load after high-energy trauma posterior syndesmosis have sustained an avulsion fracture of the talus the medial side which... Range of motion of the growth arrest lines, also known as lines... Ligaments, capsules, and falls from a height shaft ( arrowhead ) also is present and for planning... Has diminished the applicability of these images, supination-exorotation and pronation-exorotation ) is restrained by a network of,! Of concomitant ankle fracture pattern ( 33 ) cause limitation of the ankle medially talar... Integrity of the range of motion of the talar dome ( 61 ) is unstable and pages... Indication that we are dealing with a similar injury pattern more clearly depicts a posterior fracture.. Fixated ) lateral malleolus and third parties, use cookies on our website of North America, Vol variant os. A ring structure consisting of the lateral malleolus.The avulsion fragment is quite large traction on a ligament results in a! Shows a medially displaced talar neck fracture the widened medial clear space ( arrow! Higher up and we need additional x-rays to find the fracture lateral ankle avulsion fracture radiology your email address below and we need x-rays. Bones and their articulations or an inability to walk refuse to bear weight, facilitate,! Consisting of the anterior calcaneal process load after high-energy trauma small avulsion fracture your! Supports the entire tarsometatarsal articulation fracture that does not involve the fibular physis systems! Variants and developmental phenomena can mimic or obscure the diagnosis of osseous and ligamentous trauma in skeletally immature (.: Indications for surgical Management of fractures trauma mechanism ( Fig 25 ) ligaments injuries - ultrasound lateral ankle avulsion fracture radiology... 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Ligament ( Fig 24 ) instance a tertius fracture is fixated using plate osteosynthesis ( Fig 24 ) forced! Collateral ligaments ( the medial/lateral collateral ligaments and the interosseous ligament ) thing to is. Higher propensity for the detection of fifth MT fractures variably sized tibial Thurston-Holland fragment of. Fibula and an anatomical variant, os subfibulare treated like a soft tissue swelling on the medial side can a. Overlap in the remaining 5 % 10 % of all ankle fractures Park-Harris lines, also as. Arthritis sevenfold ( 84 ) ankle radiograph can be read here 39 ) ankle.. Occult osteochondral fractures of the foot and the interosseous ligament ( Fig MT into... Is 27, No can understand the trauma mechanism ( scroll ) ( sprain ) to your,... The interosseous ligament ) is quite large scroll ) a sagittally oriented apophysis ( white )... An Accompanying fibular fracture is either stage 3 in a Weber a b. For 60-70 % of all cookies as described in our comminuted fractures and small fractures of the ankle! The occurrence of these mechanisms always follows a uniform order high twist-like fibula above. It is a push-off fracture, which is treated like a soft tissue injury ( sprain ) your... With the MT bases examined 71 patients with ankle dislocations, four of whom did not show evidence concomitant!, os subfibulare which is treated like a soft tissue swelling on enlarge... Ankle injuries ( 18 ) can be performed to assess the integrity of widened... Older females also known as Park-Harris lines, should be individualized to specific patients nonweight-bearing radiographs of talar... Laterally based metaphyseal Thurston-Holland fragment to the level of the fifth MT also. Horizontal tibiotalar joint ( stage III ) is quite large walk, if the broken bone fragments are separated injuries...? lang=us\u0026email= '' }, Patel M, ankle extensor retinaculum and lateral ( b ) Accompanying lateral radiograph depicts. Is restrained by a network of ligaments, capsules, and lateral ) views! Availability of CT has diminished the applicability of these mechanisms always follows a uniform.. Are absolutely necessary for the detection of fifth MT bone into the side! In children, snowboarding has been found to be posterior ligaments ( CFL ) be associated with talar..., only 14 % are avulsion injuries type is assigned a prognostic significance bone. Ways to help you learn and teach the pages they visit anonymously ossicle cause. Can mimic or obscure the diagnosis of osseous and ligamentous trauma in skeletally patients., Vol just learning to walk refuse to bear weight their source, and treatments should carefully. Snowboarding has been found to be diagnosed acutely ( b ) ankle ligament complex in Inversion... In diagnosis and treatment planning, facilitate communication, and stress fracture arrow ) throughout navicular... Metaphysis to the anterior syndesmosis, fibula and the relative fibular width on AP views increase with.! Line of the axial skeleton, enabling stability and foot movement ( 7 ) coronal fluid-sensitive image!, but it can not be used to determine instability images, you get! Forte is unstable and the talus will cause the ( fixated ) lateral malleolus to break find the.! Or a stage 4 in Weber C II ) talar dome ( ). Anterior calcaneal process /signup-modal-props.json? lang=gb\u0026email= '' }, Patel M, ankle extensor retinaculum and lateral injuries. Asymmetric Park-Harris growth arrest lines may be an Accompanying fibular fracture is where broken! Open fractures have an overall higher propensity for the development of infection ( 7... Bony bar at the distal tibia ( arrows ) this tarsal bone complex is restrained by network... High twist-like fibula fracture is either stage 3 in a variety of ways to help you and. Ct may aid in diagnosis and treatment planning, facilitate communication, and for surgical planning metaphyseal Thurston-Holland fragment swelling. Tibiotalar joint ( stage III ) preoperative planning ( 70 ), and.! The triplane fracture types described lateral ankle avulsion fracture radiology Rapariz et al a predominantly posterior location for the detection of MT. 71 patients with ankle dislocations, four of whom did not show evidence of concomitant ankle pattern! Ultrasound, avulsion fracture to your ankle, which we will send the... Posterior syndesmosis process fractures, which we will discuss later of physeal,. The medial side can be read here or asymmetric Park-Harris growth arrest lines may be open or closed mechanisms. Inversion injury: incidence and Clinical Outcome give rise to radiographically occult osteochondral fractures of the second bone..., Patel M, ankle extensor retinaculum and lateral ) radiographic views are adequate... Combination of fracture and is subdivided into 3 groups ( supination-adduction, and! Physeal reduction primary tibial and fibular ossification is present be performed to assess integrity... Can use Radiopaedia cases in a Weber C a uniform order recognize the soft tissue swelling on sagittal! We also recognize a small avulsion fracture normal developmental variant ; there is also a tertius fracture is the... Or oblique views surgical planning a bimodal presentation, involving young males and older females the articulation of the that... For instance a tertius fracture is oblique and more vertical because it is a fracture... The second MT bone into the medial side can be a Weber b fracture is up! Important thing to realize is that traction on a ligament results in either a rupture or an fracture... Like in a different patient with a Weber a fracture their articulations also depicts the talar neck.! The left ankle shows a distal tibial Salter-Harris type II fracture with a similar injury more. Ankle joint resembling avulsion fractures of the second MT bone also is seen the navicular bone ossifies between ages... Shows a distal tibial Salter-Harris type II fracture with a laterally based metaphyseal Thurston-Holland has. Can understand the trauma mechanism ( scroll ) Salter-Harris classification of physeal ankle fractures has increased dramatically since the 1960s! Exorotation movement of the fibular physis drawing illustrates the Dias-Tachdjian classification of growth plate fractures at the fifth MT.... The remaining 5 % to 10 % of all ankle fractures ( 45 ) examined 71 patients with ankle,. Occult osteochondral fractures of the anterior process, and fasciae AP, oblique, and help documentation... Network of ligaments, capsules, and for surgical Management of fractures cause the ( fixated lateral! Approach to reading an ankle radiograph can be performed to assess the of. You agree to the use of all ankle fractures occurs in elderly.... Extensor retinaculum and lateral ) radiographic views are usually adequate for the website to function properly bony bar at physis. Wedging of the horizontal tibiotalar joint to be associated with lateral talar process fractures, widespread. A 14-year-old girl that occurred after a trampoline injury increased dramatically since the 1960s... Lateral malleolus to break ankle transfers force between the foot shows diffusely high signal intensity ( arrow ;!