Ankle Flashcards
What are the 3 types of ankle fractures?
Uni-malleolar
Bi-malleolar
Tri-malleolar
What is the definition of an ankle fracture?
A fracture of any of the malleoli with or without disruption to the syndesmosis
What are the 3 components that make up the syndesmosis?
Anterior inferior tibiofibular ligament
Posterior inferior tibiofibular ligament
Intra osseous membrane
What rules are used to determine whether imaging is required if you are unsure if there has been an ankle fracture?
Ottawa ankle rules
When do the Ottawa ankle rules indicate you need a plain radiograph for an ankle injury?
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
What are the 3 malleoli of the ankle?
Medial (tibia)
Lateral (fibula)
Posterior (tibia)
What is the approach to managing and assessing an ankle fracture?
A-E
NV status
Analgesia
Stop weight bearing
Elevate leg (reduce swelling)
X-ray
NBM
Fluids
What is the imaging of choice for assessing ankle fractures?
Plain radiograph of ankle
What are the 3 x-ray views required to assess an ankle fracture?
AP
Lateral
Mortise (10 degrees internally rotated)
What is feature is visible on x-ray if there has been disruption to other syndesmosis?
Tatar shift
What is Talar shift?
When the talus translates so it no longer fits perfectly within the mortise of the tibia
What is the Danis Weber classification of ankle fractures?
Describes the level of ankle fracture SPECIFICALLY LATERAL MALLEOLAR FRACTURES in relation to the syndesmosis
What are the 3 categories of the Danis Weber classification of ankle fractures?
A
B
C
What is a class A Danis Weber fracture?
How stable is this?
Fracture below the level of the syndesmosis
The most stable class
What is a class B Danis Weber fracture?
How stable is this?
Fracture at the level of the syndesmosis
Less stable than class A
What is a class C Danis Weber fracture?
How stable is this?
Fracture above the level of the syndesmosis
Least stable class
How do you treat/manage ankle fractures?
Analgesia
Fracture reduction (+post fracture x-ray and Neurovasular assessment)
Immobilise (conservative)
Surgical (ORIF)
How are ankle fractures immobilised following reduction?
Below the knee back slab
What ankle fractures can be managed conservatively (just below knee back slab)?
Weber A fractures
Weber B with no talar shift
Non displaced medial malleolar fractures
What ankle fractures will require surgical management? (ORIF)
Weber B with talar shift
Weber C
Displaced bi or trimalleolar fractures
OPEN FRACTURES
What are some complications of ankle fractures?
Inc risk post traumatic osteoarthritis
ORIF Risks:
-infection
-NV injury
-non union
-DVT/PE
What is a maisonneuvre fracture?
Injury of ankle occurs leading to force transmitting up the interosseous membrane leading to a break of the fibula head
What nerve is at risk in a maisonnneuvre fracture?
Common fibula nerve since it wraps around the head of fibula
What is a pilot fracture?
Fracture of the distal tibia due to impaction of the talus
How does an Achilles tendon rupture present?
Ankle pain
Struggle to plantar flex
Cant weight bear
Swelling around posterior ankle
Cant see continuity of tendon
What clinical test can be used to assess for Achilles tendon rupture?
Simmonds test
What is a positive simmonds test?
What is a negative Simmonds test?
+ve = reduced ankle movement on calf squeeze indicative of partial or complete Achilles rupture
-ve = normal ankle movement on calf squeeze
What Ix is done to assess severity of Achilles tendon rupture?
US of the tendon
What is the conservative management of Achilles tendon rupture?
Equinous boot for 6-8weeks where you gradually reduce the angle of plantar Flexion
Analgesia
What is the surgical management of Achilles tendon rupture?
When is it done?
Why?
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
What are the risk factors of Achilles tendon rupture?
Unfit people suddenly increasing amount of exercise
Male
Obese
Fluroquinolones
Poor footwear choice
What part of the foot is involved in hallux ValGUS?
1st metatarsalphalangeal joint
What is the positioning of the joint in hallux ValGUS?
1st metatarsal deviates MEDIALLY with LATERAL deviation of the phalanges with or without rotation with joint subluxation
What are the risk factors of hallux ValGUS?
Female
Connective tissue disorders
Anatomical variance
Age
How does hallux ValGUS normally present?
Older woman
Pain on side of big toe
Rubs in shoe
Progressively worse
Visible deformity
What imaging is done to assess hallux ValGUS?
Plain radiograph
What is the conservative management for hallux ValGUS?
Analgesia
Appropriate footwear
Physio
What bones does the Lis Francs ligament complex run between?
Medial cuneiform and base of the 2nd metatarsal
What is the function of the Lis Francs ligament?
Aids stability of the mid foot
How is the Lis Francs ligament complex normally injured?
Severe rotational or translation forces on a PLANTAR flexed foot
What is normally visible on a plain radiograph of a Lis Francs injury?
Widening/shifting of the gap between the 1st and 2nd metatarsal
What has a better prognosis?
Lis francs injury involving just an avulsion fracture or Lis Francs injury involving only the Lis Franc ligaments
Just bony involvement
Bones heal, the ligaments struggle to heal
How does a Lis Francs injury present?
Severe pain (mid foot)
Swelling + tenderness of mid foot
Plantar bruising
How is a Lis Francs injury managed?
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)
What is the likely injury?
Inverted foot
Immediate pain and swelling on lateral side of foot
Avulsion fracture of 5th metatarsal
What tendon is responsible for causing an avulsion fracture of the 5th metatarsal?
Fibularis brevis
What is the Definiton of an avulsion fracture of the 5th metatarsal?
Fracture extends to the 5th metatarsal base to the cuboid bone
What is the other type of avulsion fracture of the 5th metatarsal?
Jones fracture
What is a jones fracture?
Inversion injury which extends between the 5th metatarsal base and 4th metatarsal
What is the concern with an Avulsion fracture of the 5th metatarsal?
Has a retrograde blood supply from the nutrient artery so risk of AVN
Where does the fibularis longus tendon insert?
What is its function?
Runs under sole of the foot to the base of the 1st metatarsal;
Everts foot
