Physical Examination Patients with<unk> s may have variable findings on physical examination. Generally, the injured side should be compared to the non-injured side. The skin should be carefully examined, paying particular attention to any openings or breaks in the skin that could be due to an open fracture. It is important to evaluate the exact location of the pain, the range of motion of the<unk> , and the condition of the nerves and blood vessels. It is also important to palpate the calf proximally (near the knee) because there may be an associated high fibula fracture (Maisonneuve fracture). Imaging Imaging for evaluation of<unk> s can include x-rays, CT scans, and MRIs. Typically evaluation begins with x-rays, which can provide information about the mechanism of injury, severity of injury, and stability of fracture. The Ottawa<unk>  rules determine the necessity of obtaining x-rays in patients with acute<unk>  injuries. These guidelines were created to minimize the expense of unnecessary x-rays. X-ray Views There are three x-ray views in a complete<unk>  series: anteroposterior (AP), lateral, and oblique (or "mortise view"). The mortise view is an AP x-ray taken with the<unk>  internally rotated 15-20 degrees since the foot is naturally externally rotated relative to the<unk> . In addition to these views, a full-length view of the tibia and fibula may be necessary to evaluate for injuries to the proximal fibula associated with Maisonneuve fractures. A specialized AP stress view of the<unk>  is performed when there is concern for an unstable<unk>  injury. There are two types of stress views: gravity and mechanical. In the gravity stress view, the patient lies in the lateral decubitus position with the<unk>  dangling over the edge of the table to mimic the mechanical stress view. Findings On X-rays, there can be a fracture of the medial malleolus, the lateral malleolus, and/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. AP manual stress view showing a deltoid ligament tear File:TriplanefractureXa.A triplane fracture of the<unk>  as seen on plain X-ray File:TriplanefractureCT2.A triplane fracture of the<unk>  as seen on CT File:TriplanefractureCT1.A triplane fracture of the<unk>  as seen on CT CT CT scans may be indicated when there is concern for a highly comminuted fracture or a fracture involving the joint surface. This imaging may be used for surgical planning. MRI MRI is less commonly used to diagnose<unk> s but may be used to show problems involving the soft tissues (ligaments and tendons) and articular cartilage. Classification Danis-Weber classification (type A, B and C) There are several classification schemes for<unk> s. Out of the following, the Lauge-Hansen and Danis-Weber classification systems are most commonly used. * The Lauge-Hansen classification categorizes 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 categorizes<unk> s 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 Other classification schemes: * The Herscovici classification categorizes medial malleolus fractures of the distal tibia based on level. * The Ruedi-Allgower classification categorizes pilon fractures of the distal tibia. Pediatric fracture types * Wagstaffe-Le Fort avulsion fracture¨, a vertical fracture of the antero-medial part of the distal fibula with avulsion of the anterior tibiofibular ligament. * Tillaux fracture, a Salter–Harris type III fracture through the anterolateral aspect of the distal tibial epiphysis. * Triplane fractures are a special type of fracture that involves the immature skeleton. It has a coronal plane in the metaphysis, an axial plane in the physis and a sagittal plane in the epiphysis. File:Tillaux-Fraktur 11jw - Roe ap und seitlich - 001.Tillaux fracture
Ankle fracture
Elbow fracture
Humerus fracture
Ulna fracture
Hip fracture
Femoral fracture
Hume fracture
Jefferson fracture