Executive Editor: Steve Krikler
Authors: Paulo Barbosa, Felix Bonnaire, Kodi Kojima, Paul Demmer
Malleoli
back to skeleton
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Infrasyndesmotic, lateral isolated ligament rupture/avulsion fracture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Functional treatment
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All infrasyndesmotic lateral ligament ruptures and avulsion fractures |
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Circular cast
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All infrasyndesmotic lateral ligament ruptures and avulsion fractures |
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Infrasyndesmotic, lateral isolated fracture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Functional treatment
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Minimally displaced fractures, patients not fit for surgery, soft-tissue compromise, nonambulant patient |
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Circular cast
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Minimally displaced fractures, patients not fit for surgery, soft-tissue compromise, nonambulant patient |
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Tension band wiring
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Higher demand patient, small distal fragment |
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Tension band plate
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Higher demand patient; large distal fragment |
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Infrasyndesmotic, medial fracture with lateral fracture/avulsion
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient |
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External fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Triangular external fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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ORIF
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Most fractures when the patient is fit and soft tissues do not preclude surgery |
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Infrasyndesmotic, posteromedial fracture with LCL rupture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient |
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External fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Triangular external fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Lag screw
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Large posteromedial fragment, good bone quality |
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Infrasyndesmotic, posteromedial fracture with lateral fracture/avulsion
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient |
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External fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Triangular external fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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ORIF
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Most fractures when the patient is fit and soft tissues do not preclude surgery |
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Transsyndesmotic, lateral isolated simple fracture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Undisplaced or reduced fractures, marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
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Lag screw and neutralization plate
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Displaced fractures, loss of initial reduction, good bone qualtiy, anterior tibial tubercle avulsion (fixed with independent lag screw) |
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Antiglide plate
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Displaced fractures, osteoporotic bone, small distal fibular fragment, Le Fort fibular avulsion (fixed independently) |
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Transsyndesmotic, lateral isolated multifragmentary fracture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Undisplaced or reduced fractures, marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
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External fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Triangular external fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Bridging plate
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Significant comminution |
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Antiglide plate
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Displaced fractures, osteoporotic bone, small distal fibular fragment, Le Fort fibular avulsion (fixed independently) |
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Transsyndesmotic, lateral simple fracture with deltoid rupture
Please select a treatment option:
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Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
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External fixation
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Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
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Triangular external fixation
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Damage control in polytrauma, excessive soft-tissue swelling |
 |
 |
Transsyndesmotic, lateral simple fracture with medial fracture
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
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Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
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Most fractures when the patient is fit and soft tissues do not preclude surgery |
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Transsyndesmotic, lateral multifragmentary fracture with medial injury
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
|
Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
 |
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Transsyndesmotic, posterior, lateral simple fractures, and deltoid rupture
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
|
Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
 |
 |
Transsyndesmotic, posterior, lateral simple, and medial fractures
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
|
Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
 |
 |
Transsyndesmotic, posterior, lateral multifragmentary, and medial fractures
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Circular cast
|
Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
 |
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Suprasyndesmotic, simple fibular fracture, medial injury, +/- posterior fracture
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Long-leg circular cast
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Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
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Suprasyndesmotic multifragmentary fibula, medial injury, +/- posterior fracture
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Long-leg circular cast
|
Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
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Most fractures when the patient is fit and soft tissues do not preclude surgery |
 |
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Suprasyndesmotic, proximal fibular fracture, medial injury, +/- posterior fracture
Please select a treatment option:
|
Treatment |
Indication summary |
Skill |
Equipment |
Long-leg circular cast
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Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient |
 |
 |
External fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
Triangular external fixation
|
Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) |
 |
 |
ORIF
|
Most fractures when the patient is fit and soft tissues do not preclude surgery |
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*Skill |
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Basic surgical experience, no specialized skills |
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Some specialized surgical experience |
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Highly experienced and skilled surgeon |
*Equipment |
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Basic equipment only |
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Simple surgical and imaging resources |
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Full specialized surgical and imaging resources |
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