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Orthopaedics (Surgery) > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

what is the syndesmosis of the ankle

A

its a strong fibrous structure that joins the tibia and fibula together

its comprised of the anterior inferior tibiofibular ligaments (AITFL), the posterior inferior tibiofibular ligament (PITFL) and the intra-osseous membrane

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2
Q

what is the best definition of an ankle fracture

A

fracture of any malleolus (posterior, medial or lateral) with or without disruption to the syndesmosis

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3
Q

what are the different types of ankle fractures

A

isolated medial and isolated lateral malleolus fractures

bimalleolar fractures (medial + lateral)

trimalleolar fractures (medial + lateral + posterior)

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4
Q

what classification is used in ankle fractures and describe it - what type is the most unstable

A

Weber classification

Type A - below the level of 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 chance of ankle instability, therefore type C weber fractures almost always need surgical fixation

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5
Q

what type of ankle fractures are the most unstable

A

weber type C ankle fractures (above the syndesmosis)

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6
Q

what is talar shift and why is it important

A

talar shift is when the space between the medial border of the talus bone and the lateral border of the medial malleolus has increased

its important because talar shift is an indicator of instability

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7
Q

what type of fractures would be suitable for conservative management

A

minimally displaced fractures

weber type A or Type B (with no talar shift) fractures

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8
Q

management of ankle fractures

A

conservative; immediate fracture reduction (to restore anatomical alignment), below-knee backslab

surgical; ORIF (displaced fractures, weber type C, open fractures, weber type B with talar shift)

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9
Q

what are the main complications following fractures and surgical fixation (for all fractures)

A

post-traumatic arthritis

mal-union

neurovascular injury

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10
Q

ankle sprains can be injuries to what ligaments and which is most common

A

anterior talofibular ligament

calcaneofibular ligament (more common)

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11
Q

what is the main mechanism of injury in a calcaneus fracture

A

fall from height - significant axial loading directly onto the bone

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12
Q

how are calcaneus fractures classified

A

intra-articular (more common) - involves articular surface of the subtalar joint (talus and calcaneus)

extra-articular - usually avulsion fractures by the achilles tendon

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13
Q

gold standard investigation into calcaneal fractures

A

x-ray initially to diagnose the fracture

but CT scan is gold standard in calcaneal fractures

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14
Q

management of calcaneal fractures

A

conservative; cast immobilisation (most calcaneal fractures are intra-articular and as such usually require surgical intervention)

surgical; closed reduction can be attempted in large but minimally displaced fractures, ORIF is most common

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15
Q

what is achilles tendonitis

A

inflammation of the achilles tendon

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16
Q

what is the role of the achilles tendon and what muscles does it unite

A

it unites the gastrocnemius, plantaris and the soleus

it inserts into the calcaneus and produces plantarflexion at the ankle

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17
Q

what is the mechanism of an achilles tendon tear

A

when a substantial sudden force is applied across the tendon

the precipitating event is often a sudden jump or a sudden change in direction when running

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18
Q

risk factors for achilles tendonitis or rupture

A

unfit individual who has a sudden increase in exercise frequency

poor footwear

male gender

obesity

19
Q

clinical features of achilles tendonitis

A

gradual onset pain and stiffness in the posterior ankle, often worse on movement

tenderness over the tendon on palpation

20
Q

clinical features of an achilles tendon rupture

A

sudden onset very severe pain in the posterior calf

audible popping sound

loss of power of ankle plantarflexion

21
Q

investigations into achilles tendon rupture

A

clinical diagnosis

22
Q

management of achilles tendonitis and rupture

A

tendonitis; ice, NSAIDs, rehab and physio

rupture; analgesia and immobilisation, ankle splinted in plaster in full equinus (plantarflexed) (nowadays usually a moonboot is used)

23
Q

what is the common mechanism of injury of a talar fracture

A

typically high energy trauma in which the ankle is forced into dorsiflexion

this causes the talus to press against the tibia and fracture

24
Q

what is the talus at high risk of when fractured

A

avascular necrosis

reliant on an extra-osseous blood supply which is highly susceptible to interruption in the context of fractures

25
Q

management of talar fractures

A

broadly, all displaced fractures require immediate reduction and surgical repair, whereas all undisplaced fractures may be managed conservatively in a non weight bearing orthosis

26
Q

depending on the type of talar fracture according to the hawkins classification, what management does each require

A

type 1 = conservative

type 2-4 = closed/open reduction with definitive surgical fixation

27
Q

what is a tibial pilon fracture and what is the common mechanism of injury

A

severe fractures affecting the distal tibia - caused by high energy axial loads as it is injured when the talus is pushed up into it

associated with RTC and characterised by severe communition and soft tissue injury

28
Q

what is it important to look/check for in tibial pilon fractures

A

check for open fracture, compartment syndrome, peripheral pulses and peripheral nerves

29
Q

what peripheral nerves should be checked in tibial pilon fractures

A

superficial peroneal

deep peroneal

tibial nerves

30
Q

management of tibial pilon fractures

A

realignment of the limb and application of a below knee backslab

elevate limb and keep NBM in prep for surgery

operative treatment to reconstruct the articular surface and protect the soft tissue surrounding the joint

31
Q

what are Lisfranc injuries

A

severe injuries to the tarsometatarsal joint between the medial cuneiform and the base of the 2nd metatarsal

multiple interosseous ligaments support this area of which the Lisfranc ligament is the largest and strongest

32
Q

what is a key risk in Lisfranc injuries

A

compartment syndrome

33
Q

what is a sign that is highly suggestive of a Lisfranc injury

A

plantar bruising

34
Q

what are the 2 key radiological features of Lisfranc injuries

A

widening of the interval between the base of the 1st and 2nd metatarsals

bony fragments visible (fleck sign) in the space between the 1st and 2nd metatarsal, indicates avulsion of the Lisfranc ligaments from the 2nd metatarsal

35
Q

management of Lisfranc Injuries

A

conservative; for those with minimal displacement, cast immobilisation and non-weight bearing for 6-12 weeks

surgical; for those with clear displacement screw fixation is required

36
Q

what is the lay term for hallux valgus

A

bunion

37
Q

what is hallux valgus

A

deformity of the first metatarsophalangeal joint

characterised by medial deviation of the 1st metatarsal and lateral deviation of the halux, with associated joint subluxation

38
Q

what are the characteristic signs of hallux valgus

A

medial deviation of the first metatarsal + lateral deviation of the hallux, with associated joint subluxation

39
Q

risk factors for hallux valgus

A

anatomical variants, genetic predisposition, environmental factors

high heeled or narrow fitting shoes can aggravate it by keeping the hallux in a valgus position

40
Q

management of hallux valgus

A

conservative; analgesia , adjusting footwear to prevent worsening the deformity, physio

surgical; for those who’s QOL is significantly impacted by the condition, several surgical procedures available depending on severity of the deformity

41
Q

what is the plantar fascia and what are its origins and insertions

A

thick fibrous band of connective tissue originating from the medial process of the calcaneal tuberosity and inserting at each of the proximal phalanges

42
Q

risk factors for plantar fasciitis

A

anatomical factors

weak plantarflexors or tight gastrocnemius

prolonged standing or excessive running

obesity

unsupportive footwear

43
Q

management of plantar fasciitis

A

conservative; activity moderation and regular analgesics, adjust footwear and physio

surgical; corticosteroid injections, plantar fasciotomy

Orthopaedics (Surgery) (10 decks)

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