Moreover, further associated bony injuries should be ruled out by palpation of the talus, the calcaneus, the navicular bone, the mid-tarsal (Chopart) joint, and the base of the fifth metatarsal bone for possible crepitation or local tenderness. Clues to a probable ankle fracture include swelling, hematoma formation, and tenderness to pressure over the medial and/or lateral malleolus or over the proximal head of the fibula (high fibular fracture, the so-called Maisonneuve injury). In our experience, it is hard to distinguish an ankle fracture from a ligamentous injury reliably on the basis of the initial physical examination alone. Thus, proper anatomical reconstruction-generally involving surgery-is needed to prevent post-traumatic degeneration over the long term. For the ankle joint in particular, non-anatomical reductions and restraints lead to premature degeneration of the joint. Precise congruence of the ankle joint is essential for its proper function, and thus malpositions of traumatic origin have major adverse effects, as they alter the biomechanics of the joint and cause pathological compressive stress ( 4, 5).Īnkle fractures are generally to be regarded as joint fractures even if there is no fracture cleft in any of the articular surfaces of the joint. Because the talus is asymmetrically shaped, movement in the ankle joint is not a pure hinge movement, but rather a rotatory hinging movement around the helical axis of the joint ( 3). Powerful collateral ligaments stabilize the joint against stress from the sides: laterally, the anterior fibulotalar ligament (AFTL), fibulocalcanear ligament (FCL), and posterior fibulotalar ligament (PFTL), and, medially, the broad fan of the deltoid ligament and the plantar calcaneonavicular ligament (spring ligament), whose medial border is blended with the forepart of the deltoid ligament. The tibia and fibula are elastically bound in the fork of the ankle joint by the ligamentous structures of the syndesmosis (interosseous membrane anterior, posterior, and transverse tibiofibular ligaments) ( 1, 2). The talocrural joint is the junction of three bony structures: the distal ends of the tibia and fibula and the trochlea of the talus.
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