Causes and Treatment of Bimalleolar fractures

Topics: Ankle, Foot, Bone Pages: 9 (2023 words) Published: June 1, 2015
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Date: 14/5/15

CAUSES AND TREATMENT OF BIMALLEOLAR FRACTURES

Introduction
Ankle fractures, in particular bimalleolar fractures are very common (Hong et al 2013) and the aim of this report is to provide insight, from a scientific perspective, on the causes and treatment of these types of fractures.

ANATOMY AND PHYSIOLOGY OF THE ANKLE

The essential structures of the ankle can be categorised into the following; Bones and joints
Ligaments and tendons
Muscles
Nerves
Blood vessels

Bones And Joints
The ankle joint is comprised of three bones: the talus, also referred to as the anklebone, the tibia and the fibula (Figure 1) (Yufit & Seligson 2010). The way in which these three bones connect to form the joint and to enable movement, in particular, dorsiflexion and plantar flexion, is by the top of the talus fitting into the socket formed by the tibia and fibula (Sauer & Cooper 2013). The bottom of the talus sits on the calcaneus or the heel bone (Yufit & Seligson 2010). The way in which ankle fractures are classified is with regard to the three malleoli, also referred to as Volkmann’s triangle (Yufit & Seligson 2010). This ‘triangle’ is made up of the medial malleolus, lateral malleolus and posterior malleolus and the ankle is categorized depending on how many malleoli are fractured (Sauer & Cooper 2013). A bimalleolar fracture involves two fractures, one to each of the medial malleolus and lateral malleolus (Tourne et al 2009). Articular cartilage, highly specialized connective tissue, covers the bones inside the joint, allowing the smooth movement of bone against bone (Fox et al 2009). This cartilage is approximately 2 to 4 mm thick and is soft, acting as a shock absorber, whilst also being tough to ensure it is not easily damaged (Fox et al 2009).

Figure 1. The anatomy of the ankle (Crist 2013).

Ligaments And Tendons
Two very important structures of the ankle, particularly in regards to movement, are ligaments and tendons. The difference between these two structures is that tendons attach muscles to bones, whilst ligaments are soft tissues, which attach bones to bones (Pal 2014). Ligaments and tendons are both made of collagen, which bundles to form, what is referred to, as a rope-like structure and the thickness of these structures are what determine its strength (Pal 2014). The ligaments that make up the lateral ligament complex include the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament (Sauer & Cooper 2013). The deltoid ligament is particularly important in supporting the medial ankle. The ankle syndesmosis is point where the fibula meets the tibia and this area is supported by, the anterior inferior tibiofibular ligament, the posterior fibular tibiofibular ligament, the transverse ligament and the interosseus ligament – “a long sheet of connective tissue that connects the entire length of the tibia and fibula, from the knee to ankle” (Pal 2014). Ligaments are also important in assisting the formation of the joint capsule, which is comprised of both the ligaments surrounding the joint and...
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