Ankle and foot- fracture

Question 1

How do you decide who needs an ankle Xray

Answer 1

with near 100% senstivity, ottawa rules recommend xray if pain in the malleolar zone + any of the following:
Inability to weight bear after injury
Bone tenderness in distal 6cm of fibula (lateral malleolus)
Bone tenderness along distal 6cm of Tibia (medial malleolus)

if criteria met - XRAY

Question 2

What are the type of ankle fractures

Answer 2

Weber classification of ankle fractures
The “higher” the letter, the higher up it is
A- below syndesmosis (where the joint is)
B- at the level
C-above

displaced vs non displaced
open vs closed
reducible vs not

Question 3

Management of ankle fractures

Answer 3

All non open fractures should be promptly reduced (in AE) to reduce skin necrosis, then splint

unstable/displaced – surgical with plate (care -prefer if young)

Old- as the bones are bad might need conservative management

non displaced, no talar shift- short leg cast

Question 4

What is a Lisfranc fracture

Answer 4

tarsal-metatarsal fracture and dislocation, usually between cuneiform and 2nd metatarsal

caused by high velocity/athletic injuries (falling from height)

Question 5

Sx and Ix of Lisfranc fractures

Answer 5

present with acute athletic injury + severe midfoot pain, inability to weight bear, echymosis (usually plantar)
tender on 2nd MTP
can do instability test- press on dorsal side- can palpate it move

image== XRAY classic, better with lateral/oblique

Question 6

Management of Lisfranc fractures

Answer 6

Non-displaced, non operative- 8w cast

operative- Temp percutaneous pinning
or open reduct and internal fix

Question 7

What are metatarsal fracture and stress fractures

Answer 7

Lisfranc is a type -but usually either traumatic or Stress
traumatic ttend to be 5th metatarsal occuring with invulsion injuries of ankle

Stress- tend to involve othertwise healthy athletes- with sudden INCREASE of activity
most common 2nd metatarsal
but can be tarsal, calcaneum

Question 8

Sx and ix of metatarsal fractures

Answer 8

Pain and bony tenderness
not always sx of tauma but can be
antalgic gait

ix = Xray

Question 9

Mx of metatarsal fractures

Answer 9

reduce weight bear for a few weeks - can be with splint/boot/crutches
reduce activity for a bit
analgesia