OnExamination FRCS Trauma & Orthopedic (Updated Feb 2023) (PDF)

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Demo Question

With respect to ankle fractures, which of the following is correct?

 3 mm of talar shift leads to a decrease in tibiotalar contact by 50%
  A medial clear space > 4 mm is indicative of a deltoid ligament injury
 Concomitant osteochondral fractures of the talar dome are uncommon
 Syndesmosis injuries can only occur with a Weber C type fracture of the lateral malleolus
 The majority of fractures are due to a pronation external rotation injury Key Learning Point Normally the medial clear space (between talus and medial malleolus) should be less than 4 mm and when the medial space is > than 4 mm, then lateral shift of talus is present.   Explanation The majority of fractures occur due to a supination- external rotation injury. Syndesmosis injuries can occur with low as well as high fibula fractures. Osteochondral defects can occur in up to 40% of ankle fractures in some series. Normally the medial clear space (between talus and medial malleolus) should be less than 4 mm and when the medial space is > than 4 mm, then lateral shift of talus is present. 1mm of talar shift decreases tibiotalar contact by 50%.