Ankle Fractures: Pott's, Weber Classification & Ligament Sprains HTML

Ankle Injuries: Fractures & Sprains

Ankle injuries are the most common sports injuries. They range from simple ligament sprains to complex unstable fractures involving the malleoli.

1. Ligament Sprains

• Lateral Sprain (Inversion): Most common. Involves ATFL (Anterior Talo-Fibular Ligament) > CFL > PTFL.
• Medial Sprain (Eversion): Deltoid ligament (Stronger, less common).
• Management: RICE (Rest, Ice, Compression, Elevation). Early weight bearing as tolerated.

2. Fractures (Pott's Fracture)

Danis-Weber Classification (Based on fibula fracture level relative to syndesmosis):

• Type A: Below syndesmosis (Stable).
• Type B: At syndesmosis level (Variable stability).
• Type C: Above syndesmosis (Unstable, Syndesmosis ruptured).

Lauge-Hansen Classification: Based on foot position and force direction (e.g., Supination-External Rotation is most common).

3. Diagnosis & Treatment

Ottawa Ankle Rules (For X-ray):
X-ray only if pain in malleolar zone AND:
- Bone tenderness at posterior edge of Lateral or Medial Malleolus OR
- Inability to bear weight (4 steps).

• Stable: Walking boot / Cast for 6 weeks.
• Unstable (Bi/Trimalleolar): ORIF (Plate for fibula, screws for medial malleolus).

20 Practice MCQs

Q1. The most commonly injured ankle ligament is:

Answer: A). Injured in inversion and plantarflexion.

Q2. Weber Type C fracture is located:

Answer: B). Always involves syndesmotic rupture (Unstable).

Q3. Ottawa Ankle Rules are used to:

Answer: A). High sensitivity.

Q4. Maisonneuve Fracture involves:

Answer: A). Always check the knee in ankle injuries!

Q5. Trimalleolar fracture involves:

Answer: A). Highly unstable.

Q6. Anterior Drawer Test of ankle assesses:

Answer: A). Foot slides forward relative to tibia.

Q7. Medial Clear Space widening (> 4mm) indicates:

Answer: A). Sign of instability.

Q8. Most common mechanism for ankle fracture is:

Answer: A). SER type.

Q9. Talar Tilt Test assesses:

Answer: A). Inversion stress.

Q10. Syndesmotic screw is used when:

Answer: A). Holds tibia and fibula together.

Q11. RICE stands for:

Answer: A). Standard acute management.

Q12. Cotton Test (Hook Test) checks:

Answer: A). Intra-operative test.

Q13. Tillaux Fracture is:

Answer: A). Salter-Harris III injury.

Q14. Grade III sprain implies:

Answer: A). Significant instability.

Q15. Mortise View X-ray is taken with:

Answer: A). Shows the clear joint space.

Q16. Pilon Fracture is:

Answer: A). "Hammer" (Tibia) hitting the "Anvil" (Talus).

Q17. Deltoid ligament is on which side?

Answer: A). Strong triangular ligament.

Q18. Chronic ankle instability is treated with:

Answer: A). Strengthening peroneals is key.

Q19. Fracture blisters should be:

Answer: A). High infection risk.

Q20. Squeeze Test assesses:

Answer: A). Squeezing calf causes pain at ankle.