Ankle

Question 1

Basic Anatomy (3 ligaments)

Answer 1

• Hinge joint
• Lateral and medial malleoli - talus

1- Lateral ligament complex - anterior talofibular ligament, posterior talofibular ligament, calcanofibular ligament

2- Medial ligament

3- Syndesmosis - connects distal tibia and fibula

Question 2

What is the most commonly injured ankle ligament? What is the most common mechanism?

Answer 2

Anterior talofibular ligament

INVERSION

Question 3

Inversion Injury

Eversion Injury

Dorsiflexion Injury

Answer 3

• Inversion (more common) - ankle rolls away from body; affects weaker, lateral ligaments
• Eversion - ankle rolls in; affects medial ligament (stronger)
• Dorsiflexion injury - affects syndesmosis (“high ankle sprain”)

Question 4

Ankle Fractures

Answer 4

• more commonly w/ eversion than inversion
• Classification - uni-malleolar, bi-malleolar or tri- malleolar
• Can also have dislocation

Question 5

Ottawa Ankle Rules

Answer 5

IF 18-55 yo then only do Xray for fracture if …

• Unable to take 4 steps following injury and in ED
• Tender to palpation over distal 6 cm of medial or lateral malleolus

Question 6

Maisonneuve fracture

Answer 6

• medial ankle injury w/proximal fibula fracture

Question 7

Tx of Sprains v Fractures

Answer 7

• Sprains - conservative (Rest, Ice, Comp, Elevation) + ankle braces or air casts
• If severe sprain or instability may use posterior splint
• Fractures - open reduction and internal rotation (unless stable uni-malleolar fracture)
• Initially - splints, no wt bearing, ortho consult for surgical repair