The Ottawa ankle rules allow evidence-based decision making regarding the need for plain radiographs in patients with a traumatic ankle injury.Ī plain film radiograph is indicated in the setting of trauma if there are any of the following clinical examination findings 1: Most patients present following an episode of trauma with ankle pain, tenderness and an inability to weight bear. Risk factorsĬigarette smoking and obesity are both risk factors for ankle fractures. motor vehicle accident, sporting injury), while older patients present following minor trauma (e.g. Young patients present following injuries in relatively high-energy trauma (e.g. These fractures extend through the metaphysis (the widened part of the shaft of the bone), the physis (growth plate), and the epiphysis (end of the bone).Ankle injuries, like many fractures have a bimodal distribution. A triplane fracture is a Salter-Harris Type IV fracture involving three different fracture planes. Triplane FracturesĪ triplane fracture is a complex injury pattern seen in more physically mature adolescents when the growth plate is starting to close. Isolated distal fibular fractures generally heal well when treated with a walking boot or short-leg walking cast. These isolated fractures most often result from low-energy trauma, such as a fall from standing height. When just the fibula is injured in the ankle, it is most often a Salter-Harris Type I or II fracture. For example, the child may need only a walking boot if screws are inserted without screws, the child would have needed a cast. Internal screw fixation also adds stability and allows for less external immobilization. Open reduction surgery enables the surgeon to see the bone pieces directly and typically allows the bones to be more perfectly aligned.įrequently, the doctor will insert a metal plate and/or screws after an open reduction to maintain the bone fragment position for healing. This occurs most often because soft tissue, like muscle, gets between the edges of the bones. The child will need surgical treatment if the surgeon cannot properly align the bone pieces in a closed reduction, particularly if the fracture involves the ankle joint (Type III and Type IV fractures). If the bone fragments are successfully realigned, a cast is applied to maintain proper alignment. this is often done in the emergency room or operating room with your child sedated.
#Cpt orif distal fibula fracture skin
The first step is to realign the bones without making any cuts in the skin (closed reduction). Your child will need more aggressive treatment if the fracture pieces are displaced (moved out of normal alignment). these fractures should be healed in 4 to 6 weeks. Your child's doctor will guide you on when it is safe for your child to put weight on the injured ankle. Non-displaced FracturesĪ fracture that is properly aligned needs only to be stabilized in a walking boot or cast to allow for proper healing. Type V fractures are usually identified long after the fracture has healed when a growth disturbance develops. Often, surgical treatment is needed to better align and stabilize these fractures. It is especially critical that the bone be aligned as perfectly as possible in these fractures. Type III and type IV fractures are more prone to developing a growth disturbance, which may result in a crooked ankle. Both of these types of fractures can usually be treated without surgery.
#Cpt orif distal fibula fracture crack
Type II fractures break through part of the bone at the growth plate and crack through the bone shaft. Type I fractures break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate. (Below) The red lines in this X-ray of the ankle show the different types of growth plate fractures as they appear in the ankle joint. (Above) Standard illustrations of growth plate fracture types. MRI scans tests provide high-resolution images of both bones and soft tissues, such as ligaments. If the physical examination suggests a fracture but the X-rays do not show a fracture, the doctor may order a magnetic resonance imaging (MRI) scan.
This is especially useful when the fracture extends into the ankle joint and when surgery is being considered. CT scans can create a specific cross-section image of the ankle bones. X-rays will usually show whether a bone is normal or broken.Ĭomputed tomography (CT). The most common way to evaluate a fracture is with X-rays, which provide clear images of bone. If your doctor suspects an ankle fracture, they will order imaging tests to provide more information about your child's injury.
0 kommentar(er)
