![]() ![]() Secondary motions include dorsiflexion and plantar flexion. The primary motions of the ankle are external rotation, abduction, and adduction. Additionally, avulsion fractions at the site of attachment of the ligament may occur due to these same patterns.Īnkle fractures are created by the movement of the talus within the ankle mortise, with leverage exerted by the foot. Classically, these ligaments are injured in predictable sequences based on the pattern of injury. The ankle articulations are maintained by ligamentous support, including the lateral collateral ligaments, the deltoid (medial) ligaments, the syndesmotic ligaments, and the tibiofibular ligaments. This consideration arises because of the extensive articular cartilage coverage of the talus, which prevents direct vascular supply over much of the talar surface. A particular concern for vascular disruption should be paid to the talus due to its tenuous blood supply. Vascular supply to the ankle is complex and is derived from the three distal branches of the popliteal artery. The lateral process extends from the lateral aspect of the talar body and articulates with the fibula superiorly, and forms the anterolateral portion of the posterior facet of the posterior subtalar joint. The posterior process of the talar body is composed of medial and lateral tubercles, which form a groove through which the flexor hallucis longus tendon runs. The inferior margin of the talar neck forms the superior margin of the sinus tarsi and tarsal canal. The neck is the portion that connects the head and body and does not possess an articular surface or cartilage. The cephalad aspect of the body (talar dome or trochlea) articulates with the tibia at the tibiotalar joint. Further, the middle facet articulates with the medial process from the calcaneus (also called the sustentaculum tali). The talar body articulates with the calcaneus inferiorly at the middle (anteromedial) and posterior (posterolateral) facets. The head also articulates with the calcaneus via the anterior facet at its inferior margin (anterior portion of the subtalar joint). The talar head is covered with hyaline cartilage and articulates with the navicular bone at its anterior/distal aspect. Because of its unique role in the foot and ankle mobility, it is extensively covered with articular cartilage, and there are few muscle or tendon attachments. The talar anatomy is complex and is divided into the head, neck, and body. By extension, fractures of all three malleoli are referred to as trimalleolar fractures. Fractures involving the medial and lateral malleoli are termed bimalleolar fractures. The tibial plafond is the name given to the articular surface of the distal tibia. The lateral malleolus is the most distal extension of the distal fibula. The posterior lip of the distal tibia is often referred to as the posterior malleolus. The medial malleolus is an osseous excrescence from the medial distal tibia. The ankle joint is formed by the tibia, fibula, and talus. Though the initial evaluation is with radiography, an understanding of further evaluation with more advanced cross-sectional imaging is also important. The overall incidence is fairly equivalent between sexes, though higher in young males and older females.ĭue to the fairly common presentation of ankle fractures, knowledge of the proper imaging evaluation of this complex anatomy is important. ![]() Approximately 60% to 70% are unimalleolar fractures (predominately lateral malleolus), 15% to 20% bimalleolar, and only 7% to 12% are trimalleolar fractures. Most ankle fractures are malleolar fractures. ![]() ![]() It appears that the incidence of these fractures is increasing in developed countries, presumably secondary to the increasing number of people involved in athletic activity, including physically active elderly patients. The estimated incidence of ankle fractures is approximately 187 per 100,000 people per year. The ankle joint is one of the most commonly injured joints and the most common type of fracture to be treated by orthopedic surgeons. ![]()
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