DEFINISI

Ankle fracture atau fraktur pergelangan kaki

didefinisikan sebagai adanya fraktur pada distal
fibula atau lateral malleolus, distal medial tibia atau
medial malleolus, dan posterior distal tibia atau
posterior malleolus.

Ankle joint
Ankle joint = articulatio talocrural
Sendi engsel sinovial
Terletak antara
1. ujung distal dari tibia
2. ujung distal dari fibula
3. bagian superior dari talus.
Ujung distal tibia dan fibula membentuk rongga
yang dalam (malleolar mortise), memungkin
bagian trocklear dari talus dapat masuk ke
dalamnya.

Talocrural Joint

Talocrural Joint

Syndesmosis

3 ligamen yang termasuk dalam syndesmosis

1.Anteroinferior tibiofibular ligament (AITL)
2.Posteroinferior tibiofibular ligament (PITL)deep portion (inferior tranverse
ligament/ITL
3.Interosseous ligament (IOL)

MEKANISME INJURI

DIAGNOSIS
ANAMNESIS
Riwayat terjatuh dengan gaya memutar pada daerah pergelangan kaki
baik karena tersandung saat aktivitas sehari-hari maupun pada atlit
olahraga, kecelakaan lalu lintas yang menyebabkan ciderea pada
pergelangan kaki disertai adanya Nyeri hebat pada pergelangan kaki
dan Ketidakmampuan menumpu dengan kaki tersebut.

1.
2.
3.
4.
5.
6.

PEMERIKSAAN FISIK
Ekimosis (hematom)
Deformitas (displacement ke lateral, medial, atau posterior)
Edema
Luka terbuka
Nyeri tekan pada tulang maleoulus medial atau lateral
Pemeriksaan neurovaskular distal (palpasi arteri dorsalis pedis, tibialis
anterior dan capilary refill time)
7. Pemeriksaan motorik

PEMERIKSAAN FISIK
Inspeksi cara berdiri dan berjalan
Look
Warna kulit (ekimosis,eritema)
Swelling
deformity
Feel
Suhu
Pulse
Oedema
Nyeri
Move
Dorsoflexi, plantar flexi, inversi, eversi
Stand on tiptoes
Walk on tiptoes

PEMERIKSAAN
PENUNJANG

An ankle x-ray series is only required if there is any pain in the malleolar zone and any of
these findings:
1.bone tenderness at A OR
2.bone tenderness at B OR
3.inability to take 4 complete steps both immediately and in ED
A foot x-ray series is only required if there is any pain in the midfoot zone and any of these
findings:
1.bone tenderness at C OR
2.bone tenderness at D OR
3.inability to take 4 complete steps both immediately and in ED

KLASIFIKASI

Klasifikasi Lauge-Hansen

Cedera supinasi-eksternal rotasi

(SER) dan Supinasi Adduksi (SA)

Cedera pronasi-eksternal rotasi

(PER) dan pronasi-adduksi (PA)

Klasifikasi Danis-Weber

The Danis-Weber
classification system
for rotational ankle
fractures

AO/Orthopedic Trauma
Association system(OTA)

TATALAKSANA

KOMPLIKASI
1.

EARLY COMPLICATIONS
Cedera vaskular
Infeksi
Ruptur tendon achilles
Compartement syndrome

2.

LATE COMPLICATIONS
Mal-union
Non-union
Joint stiffnesss
Algodystrophy
Osteoartritis sekunder

PROGNOSIS
Ad vitam
: ad bonam
Ad functionam : dubia ad bonam
Ad sanationam : dubia ad bonam

Radiographic diagnosis
of fractures

FRAKTUR

1.
2.
3.
4.
5.
6.

Hilangnya kontinuitas tulang

Cause : - trauma ; - stress ;
-phatological
Klasifikasi :
Complete
Incomplete
Displaced
Undisplaced
Close/simple
Open/compound
Pattern :
Transverse
Oblique
Spiral
Comminuted (2 atau lebih fragmen)
Compressi
Depresi (skull)

Pattern

rule of two
1. Two views. At 90 degrees, usually anteriorposterior and lateral.
2. Two joints. The joints above and below.
3. Two occasions. Some fractures are not
easily visible immediately after trauma.
4. Two limbs. If required for comparison.

10 simple rules to follow

1 Two views: one view is one view too few

2 Two joints: image the joint above and below a long bone
3 Two sides: compare the other side (difficult cases only)
4 Two abnormalities: look for a second abnormality
5 Two occasions: compare current films with old films (especially
for chest radiographs)
6 Two visits: repeat the film after a procedure or after an interval
7 Two opinions: ask colleague for opinion or use red dot system
8 Two records: write down clinical and radiographic findings
9 Two specialists: also get a formal radiological report
10 Two examinations: do not forget other tests such as ultrasonography, computed tomography, magnetic resonance imaging,
and isotope bone scanning

Identitas foto ( nama, usia, tanggal )

Bone
Is the bone regular, or is there a gross
abnormality? If so describe it.
Is the cortex intact? Follow the entire cortex and
look for any discontinuity.
Fractures:
- Location (Epiphysis/ Metaphysis/ Diaphysis ;
Proximal, Mid or distal third)
- Pattern
- Deformity . All deformities are described as
distal fragment relative to proximal fragment.
Is there any change in bone density?
-Radio-lucent, thinner than surrounding bone
-Radio-opaque = thicker than surrounding bone

Joints
Is the joint in the correct position? Is it
dislocated- which direction?
Does a fracture involve the joint?
Are there any features of joint damage or
degeneration?

Soft tissues
Is there any evidence to suggest this is an open
fracture?
Can you see any localised swelling?

ABCs systematic assessment

Peripheral and axial skeleton
Alignment Cartilage and joints
Bones Soft tissues and foreign bodies
Cervical spine (thoracic spine and lumbar
spine) Adequacy, all lines and tubes, and
airway
Alignment
Bones
Cartilage Check disc spaces and joints
Soft tissues (prevertebral, paravertebral, and
psoas)

 http://www.blackwellpublishing.com/content/BP
L_Images/Content_store/Sample_chapter/9780727
915283/9780727915283_4_001.pdf
http://apps.who.int/iris/bitstream/10665/42457/1/
9241545550_eng.pdf