Potts fracture

Not to be confused with potts disease

Most obvious injury is # of 1 or both

malleoli along with rupture of one or more

ligaments.

Mechanism of injury
Fall
Foot anchored to the ground while body

lunges forward.
combined abduction external rotation from
an eversion force.
If malleolus pushed off # is usually oblique,
if pulled off it is transverse.

Denis weber classification

Clinical features
h/o twisting injury
Intense pain
Inability to stand on leg
Swelling
Tenderness
If both medial & lateral sides are tender

then double injury suspected

Anterioposterior view, lateral view & oblique views mig

Treatment
Dont delay treatment
Treat entire injury
Reduce accurately
Check & maintain reduction

Objective of treatment
Fibula restored to full length
Talus must sit squarely in mortise
Medial joint space restored to normal width
Oblique x-ray shows no tibiofibular

displacement

Undisplaced weber-A
fractures
Usually stable

Firm bandage or plaster cast till # heals

Undisplaced weber-B & C

fracture

Below knee cast with ankle in neutral

Check x-ray every 2 weeks
Cast discarded after 6-8 weeks
Active ankle-foot ex. after removal of cast

Displaced weber-A fracture

Internal fixation of malleolar fragment with

one or two screws directed almost parallel

to ankle joint
Loose bone fragments removed
Lateral malleolar fracture fixed with plates,
screws or tension band wiring
Post operatively a walking cast applied for
6 weeks

Displaced weber-B fractures

Common pattern is spiral # of fibula &

oblique # of medial malleolus

Closed reduction by traction & internal
rotation of foot
If closed reduction succeeds then cast is
applied
If it fails, then operative treatment in the
form of internal fixation is advised

Displaced weber-C fractures

Almost all type-c # are unstable and need

open reduction & internal fixation

1st step is to reduce the fibula, restore its
length and fix it with plate & screws
Then syndesmosis is checked. If its open it
suggest ligament damage
Syndesmosis is stabilized by inserting
transverse screw across from fibula into the
tibia

Post-op management
Movements regained before applying below

knee plaster cast

Then patient allowed partial wt-bearing
with crutches
Cast is kept for 6-12 weeks till # is
consolidated

Early complications
Vascular injury
With severe fractures pulses may be

changed
Wound breakdown & infection
Diabetics are at high risk for developing

necrosis & deep infection

Late complications
Incomplete reduction
Non union
Joint stiffness
Osteoarthritis