1- For mechanisms:
A- 5% Water supply:
Fracture sub-ligament (compared to the tibiofibular ligament) -> fracture tillaut. The line is horizontal external malleolus located below the tibiofibular ligament (= fibula fibula). The in-line ankle dull is oblique.
– There is no diastasis tibiofibular
B- 30% Abduction:
The above-ligament fractures are called Dupuytren fracture: the line is horizontal or outer ankle comminuted above the tibiofibular ligaments are broken. The line is horizontal internal malleolus under the ceiling of the mortise
– There is a tibiofibular diastasis
C- 65% External rotation:
Fractures are extra-low or ligament interligamentaires: the line is oblique or outer malleolus spiroid above or between 2 tibiofibular ligaments.
The line is horizontal internal malleolus under the ceiling of the mortise
– The tibial-fébulaire diastasis is possible only in the above-ligament forms for breach of tibiofibular ligament.
However in the forms interligamentaires diastasis is actually intra-fibular.
2- Equivalents:
An equivalent Bimalleolar fracture matches:
– Or to the combination of a fracture of the lateral malleolus and a ruptured medial ligament
Or – a combination of a fracture of the medial malleolus and a rupture of tibiofibular ligaments, and high fracture located fibula (fibula) with a lesion of the interosseous membrane Maisonneuve fracture
NB: impairment of the peroneal nerve may appear during a Maisonneuve fracture
3- Clinic:
In fractures by rotation and abduction (the most common) is observed
* From the front: a cross-sectional enlargement of the kick, a blow of ax external, internal projects and external translation with foot pronation and abduction (reverse deformation occurs in fractures by adduction)
* In profile: posterior subluxation with an earlier projection of the tibial pilon, a shortening of the forefoot, an accentuation of the concave heel and moderate equinus.
In the case of an associated dislocation: there are significant dermal pain area in the anteromedial sector by major tension of the skin -> an emergency reduction is required (maneuver hard boot and lateral translation)
4- Treatment:
A- orthopedic treatment:
The reduction must be perfect and the asset is provided by a raw-ro-leg cast, knee flexed at 20 ° and 90 ° for up to 6 or 8 weeks and plaster boot -> 4 weeks. (3 months in total).
Indicated in cases of fracture was stable, no o little moved with a proper skin condition
Fractures interligamentaires -> the most frequent and the most stable.
B- Surgical treatment:
open pit and bone reduction. Plaster boot for 3 months
Stage III Cauchoix -> external fixators
Stated before the unstable fractures and before an open fracture. The fractures are highly unstable supply
* Classification and Duparc Alnot
* Type I: sub-tuber fracture (under ligament) by adduction
* Type II fracture intertubercular by external rotation
* Type III: above-tuber fracture abduction and external rotation component more or less marked
* The bimalleolar fracture is a therapeutic emergency due to the rapid deterioration of the skin condition. Some is the therapeutic method aims to achieve anatomic reduction of the fracture.
* There are 2 global movements opposing the foot:
– Inversion: extension + adduction + supination
– Eversion: flexion + abduction + pronation
* Skin Condition
– An open fracture is treated surgically emergency (time <6 hours)
– A bad skin condition is surgical treatment differ several days pending: the reduction of edema, resorption of hematoma, improve skin suffering but makes it difficult for orthopedic treatment may be exacerbated by plaster.
* Instability criteria: lesions means union (ligaments and interosseous membranes); a trait tibial malleolus attei-Gnant the roof of the mortise, a large posterior malleolus fragment (known tibial pilon fractures beyond third of the articular surface of the lateral radiograph); the existence of an initial displacement.