Ankle And Foot Flashcards
How are ankle fractures classified?
Weber classification (for lateral malleolus fractures).
Type A = below the syndesmosis
Type B = At the level of the syndesmosis
Type C = above the level of the syndesmosis
The more proximal the injury, the higher the likelihood of ankle stability. Type C fractures almost always need surgical fixation.
What imaging should be requested for a suspected ankle fracture?
Plain film radiographs AP and lateral view of the ankle in full dorsiflexion.
Complex ankle fractures will require CT for surgical planning.
What is the management for an ankle fracture?
initial management = immediate fracture reduction (under sedation). Then below knee backslab.
Conservative management - if the patient has Weber’s A or B with no talar shift.
Surgical management - ORIF.
How are calcaneal fractures classified in general?
Intra-articular
Extra-articular
Intra-articular fractures will likely require surgical fixation.
What imaging should be requested for a suspected calcaneal fracture?
Plain film radiographs of the foot and ankle AP, lateral and oblique views.
However CT imaging is the gold standard and should be performed in all suspected cases.
What is the management for calcaneal fractures?
Non-displaced extra-articular fractures can be treated conservatively with cast immobilisation.
Most of the intra-articular calcaneal fractures require surgical intervention. This can be closed reduction with percutaneous pinning or ORIF.
What is Simmonds’ test?
Simmonds’ test is used to look for Achilles’ tendon rupture. With the patient kneeling on a chair and the affected ankle hanging off. The calf is squeezed, if plantarflexion is absent then the tendon is ruptured.
What is the management for Achilles tendonitis?
Supportive measures - stop precipitating exercise, rest, ice, NSAIDs.
If it is chronic the patient may need physiotherapy.
What is the management for Achilles tendon rupture?
Initial management (for complete and partial) = analgesia and immobilisation with the ankle in plaster in equinus position for 2 weeks. They should also be made non-weight bearing. It is then brought to semi-equinus for 4 weeks then neutral for 4 weeks.
Delayed presentations (>2 weeks) or cases of re-rupture require surgical fixation with end-to-end tendon repair.
What is the significance of a talar fracture?
The talus is reliant on extra-osseous arterial supply which is susceptible to interruption in fractures.
Therefore, the talus is at high risk of avascular necrosis after fracture.
What imaging would you do for a suspected talar fracture?
Plain film radiographs AP and lateral view. Lateral view should be taken in dorsiflexion and plantarflexion.
For complex injuries CT may be needed.
How are talar neck fractures classified?
The Hawkins classification (determines management and the risk of AVN).
1-4.
What is the management of talar fractures?
If undisplaced - conservative management. plaster cast and non-weight bearing for 3 months.
All displaced fractures require immediate reduction + then surgical repair.
The reduction can be closed in the emergency department, or ORIF if this is not possible.
What imaging should be requested in a suspected tibial pilon fracture?
Plain film radiographs, AP, lateral and mortise views. Full length views of the tibia and knee are also required.
CT is often required for pre-op planning.
What is the management for a tibial pilon fracture?
Initial management = realignment and below knee backslab. The limb should be elevated and monitored for compartment syndrome.
If it is undisplaced (rare) in can be treated conservatively.
The majority are treated surgically - surgery to reconstruct the articular surface and realign the mortise. If there is significant soft tissue swelling a temporary external fixation may be applied, followed by ORIF 1-2 weeks later once the soft tissues have healed.
