Frische verletzung des OSG

Abstract

The treatment of ankle injuries requires ascertainment of the total extent of the injury in each case. Knowledge of the basic biomechanical principles at play in this complex joint is essential. For the diagnosis, in addition to the history and the clinical examination, great importance also attaches to conventional X-ray examination. When there are particular problems with the diagnosis, functional X-rays and CT are valuable adjuncts. Classification of ankle fractures according to the Lauge-Hansen system enhances understanding of the course of the injury and is definitely helpful in the ascertainment of associated ligamentous injuries. Highly unstable injuries of the pronation-eversion type need particular attention. In these cases restoration of the syndemosis, and thus of the stability of the malleolar fork, is essential if a functionally satisfactory result is to be attained. It is technically difficult to insert the fibula in the incision, and placement of the positioning screw is also not without its pitfalls. It is not possible to check the precise alignment with an adequate level of certainty when a conventional 2D image intensifier is used. Diagnostic CT imaging should be prescribed for this purpose. Adequate quality can be achieved when this test is performed intraoperatively with a 3D image transformer. This makes it possible to avoid the logistical complications of postoperative diagnostic CT and also revision operations. © Springer Medizin Verlag 2006.