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The rules have been found to have a very high sensitivity, moderate specificity, and therefore a very low rate of false negatives. Evidence supports the rules as an accurate instrument for excluding fractures of the ankle and mid-foot, reducing the number of unnecessary investigations and length of stay in emergency departments.
[1] [2] Types of ankle fractures include lateral malleolus, medial malleolus, posterior malleolus, bimalleolar, and trimalleolar fractures. [1] The Ottawa ankle rule can help determine the need for X-rays. [2] Special X-ray views called stress views help determine whether an ankle fracture is unstable. Treatment depends on the fracture type.
A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. Studies have shown [ 1 ] that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities.
A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. The trauma is sometimes accompanied by ligament damage and dislocation. [1]
Incision is made over border of lateral malleolus; peroneal tendon exploration would require a posterolateral longitudinal incision; Surgeons care for peroneal tendons, sural nerve and lesser saphenous vein (which might be ligated), and branches of the superficial peroneal nerve;
Forceful, external rotation of the ankle joint is the main cause of a Maisonneuve fracture. [4] [7] Engaging in high-intensity sports or falling over can increase the risk of tearing the deltoid ligament or cause an avulsion fracture of the medial malleolus from external rotation of the foot.
The posterior talofibular ligament runs horizontally between the neck of the talus and the medial side of lateral malleolus calcaneofibular ligament; The calcaneofibular ligament is attached on the posteromedial side of lateral malleolus and descends posteroinferiorly below to a lateral side of the calcaneus.
Trimalleolar fracture – involving the lateral malleolus, medial malleolus, and the distal posterior aspect of the tibia; Bimalleolar fracture – involving the lateral malleolus and the medial malleolus; Pott's fracture; Foot fracture. Lisfranc fracture – in which one or all of the metatarsals are displaced from the tarsus [19]