The syndesmosis is a long interosseous membrane that holds the fibula and tibia together and is composed of 4 ligaments at its most distal end. These ligaments restrict inversion and internal rotation forces. These secure the lateral aspect of the ankle by anchoring the fibula to the foot. The lateral collateral ligaments are composed of three ligaments: the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The most common mechanism of injury that damages this ligament is foot eversion or an external rotation force due to the intense medial stresses these forces produce. When the deltoid ligament ruptures instead of the medial malleolus fracturing during a bimalleolar ankle fracture, it is known as a "bimalleolar equivalent" fracture. The deltoid ligament is the most common ligamentous injury during the medial malleolar fracture, causing joint instability. The deep portion is the strongest portion and extends from the medial malleolus to the talus. The superficial fibers extend from the medial malleolus to the navicular, sustentaculum tali of the calcaneus and the talus. These four ligaments are named the anterior tibiotalar ligament, posterior tibiotalar ligament, tibiocalcaneal ligament, and tibionavilcuar ligament, and they are divided into two portions: superficial and deep. The medial collateral ligament, or deltoid ligament, is a triangular-shaped ligamentous complex composed of 4 ligaments that stabilize the medial aspect of the ankle by anchoring the tibia to the foot. As stated above, the ankle is composed of the tibia, fibula, and talus articulating with each other, and these articulations are supported by strong ligamentous support on either side. The ankle joint is in the mortise and tenon joint classification. Also, assess if there are any signs of open wounds or compartment syndrome. Examine both the active and passive range of motion of the joint, as well as weight-bearing status. The clinician must ensure that the foot and ankle's neurovascular state is intact, including palpating pedal pulses and assessing the motor function, sensation, capillary refill time, and pulses at the injury site. The inability to bear weight on the injured foot indicates a fracture, and palpation can identify the fracture's exact location. It is also important to examine the knee, fibula, tibia, ankle, and foot and look for any signs of fracture like swelling, redness, hematoma formation, and lateral or medial tenderness malleolus or the proximal head of the fibula.
#Icd 10 code for weber b distal fibula fracture skin
On physical examination, the clinician should begin with the affected limb by examining for gross deformity and skin changes that may indicate a change in neurovascular status or open wounds that may indicate an open fracture. Higher levels of force should raise the suspicion of more complications. It can be helpful if the patient is able to describe the injurious event and the force directed toward the ankle, along with the intensity of this force. The patient history should investigate multiple aspects of the injury, including time from injury to presentation, pain location, and possibly the mechanism of injury.
So, it is necessary to ask about medication history. These should be identified before any physical exam takes place. Chronic medications such as corticosteroids can also cause prolonged healing. Important findings will include diabetes with or without peripheral neuropathy, peripheral vascular disease, osteopenia, alcohol use, tobacco use, and malignancy. A focused and thorough history should be obtained to identify any comorbidities or conditions that may be detrimental to healing.
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