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Orthopedics > 5 - Ankle > Flashcards

5 - Ankle Flashcards

1
Q

What is the Ottawa ankle rules?

A

Ankle XR is only indicated for patients who:

  • have pain in the malleolar zone
  • AND have bone tenderness at the posterior edge or tip of the lateral or medial malleolus
  • OR are unable to bear weight both immediately after the injury and for four steps in the emergency department or doctor’s office
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2
Q

What is the Ottawa foot rules?

A

Foot XR is only indicated for patients who:

  • have pain in the midfoot zone
  • AND have bone tenderness at the base of the fifth metatarsal or at the navicular bone
  • OR are unable to bear weight both immediately after the injury and for four steps in the emergency department or doctor’s office
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3
Q

What does the anterior drawer test measure?

A

integrity of the ATFL

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4
Q

What does the talar tilt test measure?

A

integrity of the CFL

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5
Q

What does the Thompson test measure?

A

achilles tendon rupture

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6
Q

Which ankle ligament is most commonly injured?

A

ATFL

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7
Q

What grade of ankle sprain is this?

Mild stretching of a ligament with microscopic tears. Patients have mild swelling and tenderness. There is no joint instability on examination, and the patient is able to bear weight and ambulate with minimal pain.

A

Grade I

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8
Q

What grade of ankle sprain is this?

Incomplete tear of a ligament. Patients have moderate pain, swelling, tenderness, and ecchymosis. There is mild to moderate joint instability on exam with some restriction of the range of motion and loss of function. Weight bearing and ambulation are painful.

A

Grade II

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9
Q

What grade of ankle sprain is this?

Complete tear of a ligament. Patients have severe pain, swelling, tenderness, and ecchymosis. There is significant mechanical instability on exam and significant loss of function and motion. Patients are often unable to bear weight or ambulate.

A

Grade III

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10
Q

In a lateral ankle sprain what is the sequence of ligament tearing that occurs?

A
  1. ATFL
  2. CFL
  3. PTFL
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11
Q

what is the mechanism of injury of a lateral vs. medial ankle sprain?

A 
lateral = plantarflexion with inversion
medial = eversion injury
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12
Q

This type of ankle sprain is the least common but has the highest morbidity.

A

high ankle sprain

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13
Q

What is the mechanism of a high ankle sprain?

A

dorsiflexion and/or rotation force

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14
Q

A positive squeeze test is consistent with this diagnosis.

A

high ankle sprain

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15
Q

Which ligament is ruptured with a high ankle sprain?

A

anterior inferior tibiofibular ligament

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16
Q

When can a patient return to physical activity following an ankle sprain?

A

when patient has full, pain-free active and passive ROM and no tenderness to palpation

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17
Q

Based on the physical exam alone, how can you distinguish an achilles tendinopathy and an achilles rupture?

A
  • achilles tendinopathy = tender along tendon + negative Thompson test
  • achilles rupture = loss of achilles contour + positive Thompson test
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18
Q

A patient presents with a burning pain and stiffness 2-6cm above the posterior calcaneus. On PE you note tenderness along the achilles tendon. Thompson test is negative. What is the diagnosis?

A

achilles tendinopathy

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19
Q

A patient presents with severe left posterior ankle pain. He was playing soccer when he felt a sudden snap while starting to sprint. On PE you note a loss of achilles contour and a positive thompson test. What is the diagnosis?

A

achilles rupture

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20
Q

A heel spur or “Halgund’s deformity” is consistent with what achilles pathology?

A

achilles tendinopathy

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21
Q

An avulsion fracture of the calcaneus is consistent with what achilles pathology?

A

achilles rupture

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22
Q

For a complete rupture of the achilles in what ankle position would you want to splint the patient?

A

in plantar flexion

23
Q

For ankle fractures, if ____ sites of significant injury are present, ankle injuries are considered unstable

A

2

24
Q

A patient presents with a fibula fracture BELOW the syndesmosis. What Weber classification is this? What is the treatment?

A
  • Weber A

- walking boot for 4-6 weeks, WBAT

25
Q

A patient presents with a fibula fracture with a characteristic posterior spike of the distal fragment. Some fibers of the syndesmosis may be torn. What Weber classification is this? What is the treatment?

A
  • Weber B
  • non-displaced: walking boot 4-6 weeks, WBAT
  • displaced/mortise disruption/syndesmosis injury: ORIF
26
Q

A patient presents with a fibula fracture ABOVE the syndesmosis. What Weber classification is this? What is the treatment?

A
  • Weber C

- ORIF always

27
Q

This is defined as a spiral fracture involving the proximal fibula and medial malleolus or rupture of deltoid ligament.

A

Maisonneuve fracture

28
Q

On every ankle injury you should palpate the __________.

A

proximal fibula

29
Q

What is the initial and definitive treatment for a Maisonneuve fracture?

A
  • initial = splint ankle at 90 degrees

- definitive = ORIF

30
Q

What is the most common long bone fracture?

A

tibia fracture

31
Q

This is a lateral deviation (valgus deformity) of the hallux on the first metatarsal.

A

hallux valgus (Bunion)

32
Q

A patient presents with numbness over the dorsal aspect of the foot between the second and fourth web spaces. He notes it feels like a pebble sensation. On PE you note a palpable nodule which reproduces paresthesias. what is the diagnosis?

A

morton neuroma

33
Q

Whenever you do a surgical procedure on the foot you begin with a _____ approach.

A

dorsal

34
Q

A 45 year old avid runner presents complaining of sharp heel pain. The pain is the worst during the first steps in the morning. On PE he has pain with palpation along the fascia while dorsiflexing toes. What is the diagnosis?

A

plantar fasciitis

35
Q

Which of the following may be the most effective in treating plantar fasciitis?

a. Cowboy boots
b. Flat shoes
c. Customized molded inserts/orthotics
d. Increasing activity
e. Cast immobilization
f. Night splints

A

a. Cowboy boots

anything that elevates the calcaneus works

36
Q

This is a sprain of the first MTP caused by forced hyperextension of the great toe against another surface.

A

Turf toe

Treatment is buddy tape

37
Q

A patient presents with right ankle pain after snowboarding in NH for the weekend. The ankle looks normal on physical exam. He denies any trauma but admits to going off a lot of jumps and some hard landings. What is the most likely diagnoses?

A

talus fractures

*all talus fracture refer to orthopedics

38
Q

What part of the talus is the most commonly fractured?

A

neck

39
Q

A patient presents with pain and swelling to the midfoot. The patient is unable to stand on their toes. On PE you notice plantar ecchymosis. What is the diagnoses?

A

lisfranc joint injury

refer to orthopedics

40
Q

What artery do you want to assess in a lisfranc joint injury?

A

dorsal pedis

41
Q

If a patient only has a soft tissue lisfranc injury what is the treatment?

A
  • splint and NWB for 6-10 weeks
  • physical therapy
  • RICE and NSAIDs
42
Q

If a patient has a lisfranc injury with bone involvement what is the treatment?

A
  • surgery

- return to sports in 9-12 months

43
Q

What is the management for a stress fracture of the metatarsal shaft?

A
  • walking boot for 4-8 weeks
  • reduce activity
  • vitamin D
44
Q

What is the management for a single non-displaced fracture of the metatarsal?

A
  • posterior leg splint, NWB, follow up

- often treated with hard soled shoes for 6 weeks

45
Q

What is the management for multiple fractures of the metatarsals?

A
  • reduction + surgery
46
Q

For foot and ankle injuries you should always palpate the ______ metatarsal.

A

fifth

47
Q

What type of fifth metatarsal fracture has the highest risk of avascular necrosis?

  • Tuberosity avulsion fractures
  • Acute proximal diaphyseal fractures
  • Stress fractures of the proximal diaphysis
A
  • Acute proximal diaphyseal fractures (Jones)
48
Q

What is the best way to tell what type of fifth metatarsal fracture a patient has?

A

use the inter-metatarsal joint as a divider

49
Q

A tuberosity avulsion fractures is _____ IMT joint

An acute proximal diaphyseal fractures (Jones) is _____ IMT joint

A stress fractures of the proximal diaphysis is _____ IMT joint

A

A tuberosity avulsion fractures (Avulsion) is BELOW IMT joint

An acute proximal diaphyseal fractures (Jones) is AT IMT joint

A stress fractures of the proximal diaphysis (Stress) is ABOVE IMT joint

50
Q

What is the treatment for a tuberosity avulsion fracture of the fifth metatarsal?

A
  • hard soled post-op shoe/walking boot 3-4 weeks

- WBAT

51
Q

What is the most common mechanism for a Jones fracture?

A

plantarflexion or vertical forces

NOT inversion

52
Q

What is the treatment for a proximal diaphyseal fractures (Jones) if it is non-displaced or displaced?

A
  • non-displaced = short leg cast 6-8 weeks, NWB

- displaced = surgery

53
Q

What is the treatment for a stress fracture of the proximal diaphysis of the fifth metatarsal?

A
  • short leg cast, NWB for up to 20 weeks

- OR surgery

Orthopedics (5 decks)

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