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Imaging II > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

What is the goal of ankle or foot radiographic examinations?

A

To identify or exclude anatomic abnormalities or disease processes

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2
Q

What are the indications for imaging of the ankle and foot?

A 
Trauma
Osseous changes secondary to metabolic disease, systemic disease or nutritional deficiencies
Neoplasms
Primary non-neoplastic bone pathologies
Infections
Arthopathies
Pre-op, Post-op, follow-ups
Congenital syndromes and developmental disorders
Vascular lesions
Evaluation of soft tissue
Pain
Correlation of abnormal skeletal findings on other imaging studies
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3
Q

What is the most frequently injured major joint in the adult body?

A

the ankle

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4
Q

What are the most commonly ordered radiographs?

A

Chest, cervical spine, ankle

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5
Q

What are the Ottawa ankle and foot rules?

A

Radiographs should only be ordered if patient is unable to bear weight, and have point tenderness in either malleolar zone, mid-foot zone, base of 5th metatarsal or navicular

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6
Q

How accurate are the Ottawa rules?

A

100% sensitivity for detecting significant fractures

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7
Q

When does ACR recommend imaging?

A

Initial study for all acute conditions (meeting Ottawa rules) and all chronic conditions

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8
Q

When is advanced imaging necessary?

A

After radiographic findings are insufficient to guide treatment or are negative when further injury is suspected

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9
Q

Which type of ankle sprain is more common?

A

Inversion, 85% of all traumatic conditions of ankle

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10
Q

What does the amount of damage to the ankle depend on?

A

The direction and magnitude of applied force at the ankle

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11
Q

Which ligaments are most commonly injured in a lateral ankle sprain?

A

Anterior talofibular and calcaneofibular

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12
Q

Do lateral ankle sprains usually involve bony involvement?

A

No

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13
Q

Do medial ankle sprains usually involve bony involvement?

A

Yes because MCL has so much tensile strength that avulsion fractures and other fractures often occur before MCL itself fails structurally and sustains damage

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14
Q

What other structures might be disrupted by a severe sprain?

A

Avulsion fractures
Syndesmotic complex
Instability

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15
Q

When is radiographic image needed for an ankle sprain?

A

If a fracture is suspected

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16
Q

How can you determine joint instability on a routine radiograph?

A

Abnormal position of talus or increased width of ankle mortise

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17
Q

When are MRIs good for ankle sprains?

A

To further define ligamentous injury

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18
Q

What is a Maisonneurve fracture?

A

disrupted interosseous membrane producing spiral fracture at proximal fibula

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19
Q

What is the treatment for ankle sprains?

A 
Conservative = cast immobilization
Surgical = screw fixation followed by immobilization
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20
Q

What is the rehab for ankle sprains?

A

Restoring joint arthokinematics, osteokinematics, strength and function ambulation and athletic skills

21
Q

What do fractures usually occur in combination with?

A

ligamentous ruptures, avulsions, and other fractures

22
Q

What is the usual MOI for an ankle fracture?

A

axial or rotational loading

23
Q

What factors are loading forces and injury patterns dependent on?

A

Chronicity of pre-existing ankle instability
Patient’s age
Bone density
Comorbidity related to soft tissue conditions
Position of foot at time of loading
Magnitude, direction and rate of loading

24
Q

What is a trimalleolar fracture?

A

Fracture to both malleoli and posterior rib of tibia (referred to as 3rd malleoli)

25
Q

Other than malleoli fractures, what other fractures are seen in ankle?

A

Shaft fractures of fib/tib
Comminuted fractures distal tib
Intra-articular fractures of tibial plafond or talar dome

26
Q

What is an important consideration when viewing traumatic radiographs?

A

Positioning won’t always be perfect due to patient’s inability to position injured extremity precisely or because injuries displacement of normal bone position

27
Q

What is the treatment for ankle fractures?

A

Stabilize fractures and reestablish architecture of ankle mortise

Immobilization via casting or surgical repair

28
Q

What are complications associated with ankle fractures?

A

Non-union and degenerative changes associated with post-traumatic arthritis

29
Q

Which foot fractures are most common?

A

Calcaneal, talus

30
Q

What is the MOI for foot fractures?

A

usually large force applied through dorsiflexed foot such as when driver slams on brakes in car accident

31
Q

How are talar fractures classified?

A

usually intra-articular because 3/5 of talus covered with articular cartilage

32
Q

What imaging should be used to see talar fracture?

A

Radiographs can see most talar fractures adequately

CT or MRI used to further evaluate pain when radiographs negative or to assist in pre-op plan

33
Q

What is the treatment for a talar fracture?

A

Non-op = indicated for non-displaced fractures, immobilization in short leg cast for 8-12 weeks and avoidance of weight-bearing for 6 weeks until radiographic healing evident

Op = treat displaced fractures in order to restore subtalar joint congruity, can either be closed reduction and immobilization, but often require open reduction and internal fixation

34
Q

What complications can occur with talar fractures?

A

Post-traumatic arthritis of ankle and subtalar joint (related to articular surface damage, prolonged immobilization for bony union, and presence of necrotic changes)
Blood supply to talus tenuous because no muscles attach to it and its cartilage-covered (predisposed to AVN after fracture)

35
Q

What are accessory bones?

A

anomalous bones that usually form because of failure of one or more ossification centers to unite with main mass of bone

36
Q

How often do accessory bones occur?

A

30% of adults have them

37
Q

What are some of the most common kinds of accessory bones?

A

Intermetatarsal ossicle
External tibial ossicle
Trigone ossicle
Os peroneum (tendon peroneus brevis, image)

38
Q

How are accessory bones differentiated from acute fractures?

A

Presence of intact, smooth cortical shell with underlying line of increased density. Acute fractures have irregular cortical surface and no appearance of increased density

39
Q

What are the routine radiographs for the ankle?

A

AP view, AP oblique (mortise view), lateral

40
Q

What are the routine radiographs for the foot?

A

AP view, lateral, oblique

41
Q

What imaging techniques are best for viewing cartilaginous fractures? Soft tissue injuries? Stress fractures?

A

CT/MRI
MRI, tenography, ultrasound
MRI, bone scan

42
Q

What is the usual MOI for the calcaneus?

A

vertebral compression in thoracolumbar spine

43
Q

What fractures are usually seen at the midfoot?

A

Sprains, dislocations at transverse tarsal and tarsometatarsal joints, an exception is stress fractures at navicular

44
Q

What are fractures are usually seen at forefoot?

A

metatarsals and phalanges usually caused by direct trauma or stubbing injuries
Stress fractures also common, usually at distal shafts of 2nd-4th metatarsals and proximal shaft of 5th

45
Q

Hallux valgus

A

first metatarsal deviated medially, great toe laterally

46
Q

Pes cavus

A

abnormally high medial longitudinal arch of the foot, calcaneal inclination greater than 30 degrees as measured on lateral side

47
Q

Pes planus

A

abnormally low medial medial longitudinal arch of foot

48
Q

Taplies equinovarus

A

Clubfoot, most common deformity. Radiographs limited value at birth, significant later in monitoring osseous growth and treatment outcomes

Imaging II (9 decks)

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