![]() 3 Initially strong indications with fracture displacement >5 mm, angulation >10°, and the presence of neurological deficits are widened also considering the potentially high morbidity, instability and secondary displacement in conservatively treated patients. Management options for odontoid fractures have expanded with advantages in imaging and surgical technologies, with a trend toward primary operative stabilization. Injury treatment aims to reestablish stability of the atlanto-axial complex. 2 This fracture type is potentially serious due to the proximity of the medulla oblongata and the great mobility of the cranial-cervical junction resulting in a high risk of life-threatening neurological lesions. 1 In the elderly population, this fracture type represents the most common cervical spine fracture and in the population older than 80 years, the most common spine fracture of all. Odontoid fractures are widely common and reported to account for up to 15% of all cervical spine injuries. As there is still some bias in the treatment algorithms, the working group recommends establishment of a prospective study to result in more objective statements. In the aged population (>80 years), operative therapy is critical as postoperative morbidity complication and mortality rates rise significantly. In these cases, posterior instrumentation or fusion of C1 and C2 is favorable. The technique is demanding and leads to elevated complication and failure rates if modifiers are apparent. Unstable and/or dislocated displaced odontoid fractures are treated by anterior osteosynthesis with 1 or 2 screws. Stable odontoid fractures are treated conservatively non-operatively, but if so regular controls have to be performed. To create an adequate treatment algorithm, dislocation displacement and instability have to be identified. The classification of Anderson and D’Alonzo is still standard. If operation is indicated, many influencing factors have to be considered for appropriate approach and technique. Conservative treatment may also be started within stable nondislocated fractures, but then regular controls have to be performed. However, in the aged population, conservative treatment should be considered as morbidity and mortality rise significantly in the group of >75 years. Operation seems to be standard treatment for odontoid fractures. Fractures of the Ankle Joint: Investigation and Treatment Options. Goost H, Wimmer M, Barg A, Kabir K, Valderrabano V, Burger C. Evaluation of the Syndesmotic-Only Fixation for Weber-C Ankle Fractures with Syndesmotic Injury. CURRENT Diagnosis & Treatment in Orthopedics, Fourth Edition. ![]() Musculoskeletal Eponyms: Who Are Those Guys? Radiographics. It was later modified and popularized by the Swiss orthopedic surgeon, Bernhard Georg Weber (1929-2002), in 1972 2. ![]() This classification was first described by the Belgian general surgeon, Robert Danis (1880-1962), in 1949. Usually associated with an injury to the medial side Weber C fractures can be further subclassified as 6Ĭ1: diaphyseal fracture of the fibula, simpleĬ2: diaphyseal fracture of the fibula, complexĪ fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint Medial malleolus fracture or deltoid ligament injury often presentįracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs ( Maisonneuve fracture) Tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation Weber B fractures could be further subclassified as 9ī2: associated with a medial lesion (malleolus or ligament)ī3: associated with a medial lesion and fracture of posterolateral tibiaĪbove the level of the syndesmosis (suprasyndesmotic) Variable stability, dependent on the status of medial structures (malleolus/ deltoid ligament) and syndesmosis may require open reduction and internal fixation (ORIF) Tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injuryĭeltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome Usually stable if medial malleolus intact treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeksĭistal extent at the level of the syndesmosis (trans-syndesmotic) may extend some distance proximally Below the level of the syndesmosis (infrasyndesmotic) ![]()
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