足関節骨折、足関節部骨折

WordNet

interrupt, break, or destroy; "fracture the balance of power"
breaking of hard tissue such as bone; "it was a nasty fracture"; "the break seems to have been caused by a fall" (同)break
fracture a bone of; "I broke my foot while playing hockey" (同)break
become fractured; "The tibia fractured from the blow of the iron pipe"
break (a bone); "She broke her clavicle"
break into pieces; "The pothole fractured a bolt on the axle"
violate or abuse; "This writer really fractures the language"
the act of cracking something (同)crack, cracking
a gliding joint between the distal ends of the tibia and fibula and the proximal end of the talus (同)ankle_joint, mortise_joint, articulatio talocruralis

PrepTutorEJDIC

〈U〉(特に)骨を折ること;骨を折った状熊 / 〈C〉割れ(裂け)目,(鉱物の)破砕面 / 〈足・腕などを〉‘を'骨折する;…‘を'砕く / 骨折する;砕ける
『足首』,くるぶし

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/04 14:40:33」(JST)

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Bimalleolar fracture and right ankle dislocation on X-ray (anteroposterior). Both the end of the fibula (1) and the tibia (2) are broken and the malleolar fragments (arrow: medial malleolus, arrowhead: lateral malleolus) are displaced.

An ankle fracture is a break of the ankle bones. It is typically diagnosed by X-ray. Treatment is with either casting or surgery.

Signs and symptoms

Symptoms of an ankle fracture can be similar to those of ankle sprains (pain), though typically they are often more severe by comparison. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. However, in the setting of an ankle fracture the talus can become unstable and subluxate or dislocate. Patients may complain of ecchymosis (bruising), or there may be an abnormal position, abnormal motion, or lack of motion.

Diagnosis

Evaluation

On clinical examination, it is important to evaluate the exact location of the pain, the range of motion and the condition of the nerves and vessels. It is important to palpate the calf bone (fibula) because there may be an associated fracture proximally (Maisonneuve fracture), and to palpate the sole of the foot to look for a Jones fracture at the base of fifth metatarsal (avulsion fracture).

Evaluation of ankle injuries for fracture is done with the Ottawa ankle rules, a set of rules that were developed to minimize unnecessary X-rays. There are three x-ray views in a complete ankle series: anteroposterior, lateral, and oblique (or "mortise view"). The mortise view an anteroposterior x-ray taken with the ankle internally rotated until the lateral malleolus is on the same horizontal plane as the medial malleolus, and a line drawn through both malleoli would be parallel to the tabletop, resulting in a position where there normally is no superimposition of tibia and fibula on each other.^[1] It usually requires 10 to 20 degrees of internal rotation.^[1]

X-ray

On X-rays, there can be a fracture of the medial malleolus, the lateral malleolus, or of the anterior/posterior margin of the distal tibia. The posterior margin (known as the posterior malleolus) is much more frequently injured than the anterior aspect of the distal tibia. If both the lateral and medial malleoli are broken, this is called a bimalleolar fracture (some of them are called Pott's fractures). If the posterior malleolus is also fractured, this is called a trimalleolar fracture.

A triplane fracture of the ankle as seen on plain X-ray
A triplane fracture of the ankle as seen on CT
A triplane fracture of the ankle as seen on CT

Classification

Danis-Weber classification (type A, B and C)

There are several classification schemes for ankle fractures:

The Lauge-Hansen classification categorises fractures based on the mechanism of the injury as it relates to the position of the foot and the deforming force (most common type is supination-external rotation)
The Danis-Weber classification categorises ankle fractures by the level of the fracture of the distal fibula (type A = below the syndesmotic ligament, type B = at its level, type C = above the ligament), with use in assessing injury to the syndesmosis and the interosseous membrane
The Herscovici classification categorises medial malleolus fractures of the distal tibia based on level.
The Ruedi-Allgower classification categorizes pilon fractures of the distal tibia.

Treatment

Surgically fixated bimalleolar ankle fracture

Treatment of ankle fractures is dictated by the stability of the ankle joint. Certain fracture patterns are deemed stable, and may be treated similar to ankle sprains. All other types require surgery, most often an open reduction and internal fixation (ORIF), which is usually performed with permanently implanted metal hardware that holds the bones in place while the natural healing process occurs. A cast or splint will be required to immobilize the ankle following surgery.

References

^ ^a ^b Ankle Injuries: A Sprained Ankle? Radiology Cases in Pediatric Emergency Medicine Volume 3, Case 3 Alson S. Inaba MD Kapiolani Medical Center For Women And Children University of Hawaii John A. Burns School of Medicine. Retrieved May 2011

External links

A site dedicated to information about Recovery from Ankle Fractures
Medical information about Ankle Fractures

UpToDate Contents

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1. 成人における足関節骨折の概要 overview of ankle fractures in adults
2. 小児における足関節骨折 ankle fractures in children
3. 腓骨骨折 fibular fractures
4. 足首の捻挫 ankle sprain
5. 若年アスリートにおける足部および足関節の疼痛評価 evaluation of foot and ankle pain in the young athlete

English Journal

Foot-ankle complex injury risk curves using calcaneus bone mineral density data.

Yoganandan N1, Chirvi S2, Voo L3, DeVogel N4, Pintar FA2, Banerjee A4.
Journal of the mechanical behavior of biomedical materials.J Mech Behav Biomed Mater.2017 Aug;72:246-251. doi: 10.1016/j.jmbbm.2017.05.010. Epub 2017 May 5.
PMID 28505593

Amputation following internal fixation of an ankle fracture via the posterolateral approach - a case report.

Sandelin H1, Tukiainen E2, Ovaska M1.
Acta orthopaedica.Acta Orthop.2017 Jun;88(3):358-360. doi: 10.1080/17453674.2016.1262679. Epub 2016 Nov 28.
PMID 27892754

Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

Labrum JT 4th1, Paziuk T1, Rihn TC2, Hilibrand AS3, Vaccaro AR3, Maltenfort MG3, Rihn JA4.
Clinical orthopaedics and related research.Clin Orthop Relat Res.2017 Jun;475(6):1527-1536. doi: 10.1007/s11999-017-5263-3. Epub 2017 Feb 21.
PMID 28224441

Japanese Journal

足関節脱臼骨折後の歩行時足関節痛に対してTSストラップが奏効した1症例

岡西尚人,田中夏樹,早川智広,稲葉将史,加藤哲弘
日本義肢装具学会誌 = Bulletin of the Japanese Society of Prosthetic and Orthotic Education, Research and Development 27(3), 181-183, 2011-07-01
NAID 10029368441