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Y3(S) - T & O > Ankle > Flashcards

Ankle Flashcards

1
Q

What are the 3 types of ankle fractures?

A

Uni-malleolar
Bi-malleolar
Tri-malleolar

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2
Q

What is the definition of an ankle fracture?

A

A fracture of any of the malleoli with or without disruption to the syndesmosis

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3
Q

What are the 3 components that make up the syndesmosis?

A

Anterior inferior tibiofibular ligament

Posterior inferior tibiofibular ligament

Intra osseous membrane

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4
Q

What rules are used to determine whether imaging is required if you are unsure if there has been an ankle fracture?

A

Ottawa ankle rules

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5
Q

When do the Ottawa ankle rules indicate you need a plain radiograph for an ankle injury?

A

Bone tenderness/pain on posterior edge or tip of lateral malleolus

Bone tenderness/pain on posterior edge or tip of medial malleolus

Inability to immediately weight bear or walk 4 steps in ED

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6
Q

What are the 3 malleoli of the ankle?

A

Medial (tibia)
Lateral (fibula)
Posterior (tibia)

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7
Q

What is the approach to managing and assessing an ankle fracture?

A

A-E

NV status
Analgesia
Stop weight bearing
Elevate leg (reduce swelling)
X-ray
NBM
Fluids

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8
Q

What is the imaging of choice for assessing ankle fractures?

A

Plain radiograph of ankle

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9
Q

What are the 3 x-ray views required to assess an ankle fracture?

A

AP
Lateral
Mortise (10 degrees internally rotated)

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10
Q

What is feature is visible on x-ray if there has been disruption to other syndesmosis?

A

Tatar shift

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11
Q

What is Talar shift?

A

When the talus translates so it no longer fits perfectly within the mortise of the tibia

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12
Q

What is the Danis Weber classification of ankle fractures?

A

Describes the level of ankle fracture SPECIFICALLY LATERAL MALLEOLAR FRACTURES in relation to the syndesmosis

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13
Q

What are the 3 categories of the Danis Weber classification of ankle fractures?

A

A
B
C

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14
Q

What is a class A Danis Weber fracture?

How stable is this?

A

Fracture below the level of the syndesmosis

The most stable class

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15
Q

What is a class B Danis Weber fracture?

How stable is this?

A

Fracture at the level of the syndesmosis

Less stable than class A

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16
Q

What is a class C Danis Weber fracture?

How stable is this?

A

Fracture above the level of the syndesmosis

Least stable class

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17
Q

How do you treat/manage ankle fractures?

A

Analgesia

Fracture reduction (+post fracture x-ray and Neurovasular assessment)

Immobilise (conservative)

Surgical (ORIF)

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18
Q

How are ankle fractures immobilised following reduction?

A

Below the knee back slab

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19
Q

What ankle fractures can be managed conservatively (just below knee back slab)?

A

Weber A fractures
Weber B with no talar shift

Non displaced medial malleolar fractures

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20
Q

What ankle fractures will require surgical management? (ORIF)

A

Weber B with talar shift
Weber C

Displaced bi or trimalleolar fractures

OPEN FRACTURES

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21
Q

What are some complications of ankle fractures?

A

Inc risk post traumatic osteoarthritis

ORIF Risks:
-infection
-NV injury
-non union
-DVT/PE

22
Q

What is a maisonneuvre fracture?

A

Injury of ankle occurs leading to force transmitting up the interosseous membrane leading to a break of the fibula head

23
Q

What nerve is at risk in a maisonnneuvre fracture?

A

Common fibula nerve since it wraps around the head of fibula

24
Q

What is a pilot fracture?

A

Fracture of the distal tibia due to impaction of the talus

25
Q

How does an Achilles tendon rupture present?

A

Ankle pain
Struggle to plantar flex
Cant weight bear
Swelling around posterior ankle
Cant see continuity of tendon

26
Q

What clinical test can be used to assess for Achilles tendon rupture?

A

Simmonds test

27
Q

What is a positive simmonds test?

What is a negative Simmonds test?

A

+ve = reduced ankle movement on calf squeeze indicative of partial or complete Achilles rupture

-ve = normal ankle movement on calf squeeze

28
Q

What Ix is done to assess severity of Achilles tendon rupture?

A

US of the tendon

29
Q

What is the conservative management of Achilles tendon rupture?

A

Equinous boot for 6-8weeks where you gradually reduce the angle of plantar Flexion

Analgesia

30
Q

What is the surgical management of Achilles tendon rupture?

When is it done?
Why?

A

Operative repair

When there is a huge gap between the rupture parts of the tendon

When a quick fix is desired or needed

Re rupture rates between conservative and surgical managemtn are the same

31
Q

What are the risk factors of Achilles tendon rupture?

A

Unfit people suddenly increasing amount of exercise

Male
Obese
Fluroquinolones
Poor footwear choice

32
Q

What part of the foot is involved in hallux ValGUS?

A

1st metatarsalphalangeal joint

33
Q

What is the positioning of the joint in hallux ValGUS?

A

1st metatarsal deviates MEDIALLY with LATERAL deviation of the phalanges with or without rotation with joint subluxation

34
Q

What are the risk factors of hallux ValGUS?

A

Female
Connective tissue disorders
Anatomical variance
Age

35
Q

How does hallux ValGUS normally present?

A

Older woman
Pain on side of big toe
Rubs in shoe
Progressively worse
Visible deformity

36
Q

What imaging is done to assess hallux ValGUS?

A

Plain radiograph

37
Q

What is the conservative management for hallux ValGUS?

A

Analgesia
Appropriate footwear
Physio

38
Q

What bones does the Lis Francs ligament complex run between?

A

Medial cuneiform and base of the 2nd metatarsal

39
Q

What is the function of the Lis Francs ligament?

A

Aids stability of the mid foot

40
Q

How is the Lis Francs ligament complex normally injured?

A

Severe rotational or translation forces on a PLANTAR flexed foot

41
Q

What is normally visible on a plain radiograph of a Lis Francs injury?

A

Widening/shifting of the gap between the 1st and 2nd metatarsal

42
Q

What has a better prognosis?

Lis francs injury involving just an avulsion fracture or Lis Francs injury involving only the Lis Franc ligaments

A

Just bony involvement

Bones heal, the ligaments struggle to heal

43
Q

How does a Lis Francs injury present?

A

Severe pain (mid foot)
Swelling + tenderness of mid foot

Plantar bruising

44
Q

How is a Lis Francs injury managed?

A

Non significant displacement and NV intact can closed reduction and immobilisation

Significant displacement or NV compromise warrants surgical intervention/temproary external fixation while swelling improves then (ORIF)

45
Q

What is the likely injury?

Inverted foot
Immediate pain and swelling on lateral side of foot

A

Avulsion fracture of 5th metatarsal

46
Q

What tendon is responsible for causing an avulsion fracture of the 5th metatarsal?

A

Fibularis brevis

47
Q

What is the Definiton of an avulsion fracture of the 5th metatarsal?

A

Fracture extends to the 5th metatarsal base to the cuboid bone

48
Q

What is the other type of avulsion fracture of the 5th metatarsal?

A

Jones fracture

49
Q

What is a jones fracture?

A

Inversion injury which extends between the 5th metatarsal base and 4th metatarsal

50
Q

What is the concern with an Avulsion fracture of the 5th metatarsal?

A

Has a retrograde blood supply from the nutrient artery so risk of AVN

51
Q

Where does the fibularis longus tendon insert?
What is its function?

A

Runs under sole of the foot to the base of the 1st metatarsal;

Everts foot

Y3(S) - T & O (7 decks)

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