Bimalleolar and Trimalleolar Fractures
Bi Malleolar fracture
Definition
Medial Malleolus and Lateral Malleolus fractured
Ankle
Anterior impingement
Definition
Impingement between anterior distal tibial osteophyte and sulcus of the talus in dorsiflexion
Epidemiology
Seen in athletes with repetitive dorsiflexion
Football / soccer / ballet / gymnasts
Pathology
Anterior osteophytes
Soft tissue impingement - scar tissue in anterolateral gutter from recurrent ankle sprains
Bassett's ligament - thickened fascicle of the AITFL
Ankle Arthrodesis
Results
90% fusion rates
Lose
70% sagittal plane ROM
Disadvantages of Arthrodesis
Non union rates up to 12%
Decreased gait speed
Poor mobility over uneven surfaces
Ankle Arthroplasty
History
First generation (late 70s early 80s)
Results
PVNS
Definition
Pigmented Villo-Nodular Synovitis
- benign inflammatory process that arises in synovial tissues
- contains significant amounts of hemosiderin
Epidemiology
Age: 20 - 50
Sex: M > F
Types
A. Diffuse
- throughout joint synovium
- more difficult to treat / excise fully
Synovial Chondromatosis
Definition
Chondroid Metaplasia of synovium affecting large joints
Nodules of hyaline cartilage
- formed in the subsynovial layer of joint capsules
Epidemiology
Rare lesion
Most common in 20's and 30's
Sex: M > F (2:1)
Monoarticular
Site
Multiple Hereditary Exostosis
AKA
Diaphyseal Aclasis / Multiple Osteochondromas
Definition
Heritable skeletal dysplasia
Epidemiology
AD with variable penetrance (96%)
Malignant Transformation
Incidence of malignant transformation much higher
- 10% overall
- 1 % / year
Chondrosarcoma (CS) > Osteosarcoma (OS)
Foot & Ankle Exam
Look
Aids
Shoes - raises / wear patterns
Stigmata generalised disease
Hands - RA, CMT
Front
Knee alignment
Forefoot - Hallux & Lesser toes
Scars
Circulatory changes
Medial Side
Turn affected side away & ask to step foot forward
Flexed attitude of knee
Medial arch - planus / cavus