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NMSK1 - physio 1 > ankle and foot fractures > Flashcards

ankle and foot fractures Flashcards

1
Q

what can cause a fibula fracture?

A
  • direct trauma to the outer leg - transverse or comminuted fracture
  • twisting injury - spiral fracture
  • repeated stress - fatigue fracture
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2
Q

what is noticed upon the initial examination of a fibula fracture?

A
  • tender
  • bruisng
  • painful and restricted ROM
  • limited WB
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3
Q

what does the treatment of a fibula fracture involve?

A
  • if the fibia is intact, PWB may be allowed
  • if it is very painful, displaced, a fatigue fracture - immobilised in cast or boot for 6 weeks
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4
Q

what are the causes of a fracture of the tibia?

A
  • high force or direct trauma - causing a transverse or comminuted fracture
  • low force or twisting injury - causing a spiral or oblique fraqcture
  • repeated stress - fatigue opr stress
  • open fracture - RTA
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5
Q

how would an undisplaced tibial fracture be managed?

A
  • long leg plaster or paris for 10-16 weeks until union
  • may be able to walk on heel or toe touch weight bear at 3-6 weeks
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6
Q

how is a displaced tibial fracture managed?

A
  • ORIF - IM nail or plate
  • long leg POP or boot for 10 weeks
  • if the fracture is open, need external fixator … temporary until the soft tissue is healed and then ORIF
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7
Q

what % of tibial fractures are associated with fibial fractures?

A

30%

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8
Q

does the fibula usually require fixation?

A

no

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9
Q

what are the **complications **of a tibial fracture?

A
  • soft tissue damage
  • ulceration
  • skin loss if open fracture
  • nerve damage
  • vascular damage
  • non union
  • delayed union
  • instability
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10
Q

what is compartment syndrome?

A
  • a condition in which the pressure in the muscles is dangerouly raised - higher than arterial and venous pressure
  • treated with fasciotomy - to decrease pressure
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11
Q

what is the normal resting pressure compared to an abnormal pressure (as seen in compartment syndrome) of the lower leg?

A
  • normal pressure - 0-8mmHg
  • abnormal pressure - 30mmhg - requires fasciotomy
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12
Q

what are important preventative measures of compartment syndrome?

A

monitoring
* pulse
* colour
* temperature
* neuropathic changes
to ensure cs is not developing

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13
Q

what are the symptoms of compartment syndrome?

A
  • abnormal amount of pain
  • swelling
  • numbess
  • paraesthesia - abnormal sensation eg prickling/tingling etc
  • painful ROM
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14
Q

what can cause compartment syndrome of the lower leg?

A

after fractures

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15
Q

in which fracture is a fat embolism common after?

A

shaft of tibia or femur

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16
Q

what can ankle fractures be associated with?

A

ligament damage

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17
Q

what are the types of ankle fractures?

A
  • isolated medial malleolar
  • isolated lateral malleolar
  • bimalleolar
  • trimalleolar
  • pilon fracture - high trauma fracture of tibia - happens near ankle
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18
Q

what is a danis weber type a lateral malleolar fracture?

A
  • below level of ankle joint
  • tibiofibular syndesmosis intact
  • deltoid ligament intact
  • medial malleolus often fractured
  • usually stable
19
Q

describe a danis weber type B lateral malleolar fracture

A
  • at the level of the ankle joint
  • syndesmosis intact or partially torn
  • medial malleolus may be fractured
  • deltoid ligament may be torn
  • variable stability
20
Q

describe a danis weber type C lateral malleolar fracture

A
  • above the level of the ankle joint
  • dyndesmosis disrupted
  • medial malleolus fracture
  • delotoid ligament injury
  • unstabke - requires ORIF
21
Q

what is a very common MOI for a lateral malleous fracture?

A
  • supination -external rotation
  • SER
22
Q

what is diastasis?

what is it, MOI, management

A
  • disrupted / seperated inferior tib-fib joint (syndesmosis)
  • caused by severe external rotation force
  • requires ORIF for 8 weeks and cast/boot for ligament healing
23
Q

what are the ottawa ankle rules?

A
  • NB - these rules are used to determine the need for deciding if patients need imaging for ankle fracture
  • useful within 1 week of initial trauma
24
Q

what are the aims of treatment for an ankle fracture?

A
  • restore and maintain normal alignment of the talus and tibia
  • ensure optimal restoration of the articulating surfaces to reduce later risk of OA
25
Q

how is a undisplaced ankle fracture managed?

A
  • ortho boot cast for 8 weeks
  • limited wb
26
Q

how is a displaced ankle fracture managed?

A
  • restore shape of joint
  • ORIF
  • ortho boot for 8 weeks
27
Q

what does the physiotherapy treatment of an ankle fracture involve once the cast is removed?

A
  • swelling education and management
  • progressibe WB
  • gait re-education
  • ROM of ankle and foot- active exercises and passive stretches
  • muscle strength - hip, knee
  • balance and proprioception exercises
  • functional activties - stairs
  • work and sport specific rehab
28
Q

what bones can be fractured in the foot?

A
  • talus
  • calcaneus
  • tarsal bone
  • metatarsal
  • phalangeal
29
Q

what can cause a talus fracture?

A
  • twisting injury or violent dorsiflexion
  • can happen to the body or neck of the talus
  • classified by hawkins type i-iv
30
Q

how is a displaced vs non displaced talus fracture managed?

A
  • no displacement - NWB and pop below knee for 6-8 weeks
  • displaced - ORIF and pop below knee & NWB for 6-8 weeks
31
Q

what are the complications of a talus fracture?

A
  • skin damage at time of injury
  • non union
  • AVN
  • OA
32
Q

What can cause a fracture of the calcenous bone?

A
  • fall from a height
  • landing on heel
33
Q

what is commonly noticed with the fracture of the calcenous bone?

A
  • avulsion of the posterior segment of achilles tendon
  • fracture of the sustentaculum tali
  • burst compression fracture
  • comminuted fractures
34
Q

compare the conservative vs surgical management of a calcaneus fracture?

A
  1. conservative
    * rest and POP - NWB gait for 6 weeks
  2. surgical
    * ORIF
    * POP or ortho boot NWB for 6-8 weeks
35
Q

what does the physio management post op involve for a calcaneous fracture?

A
  • gait re-education
  • advice for footwear for painful heel
  • orthotics?
36
Q

what tarsak bones can be fractured?

A
  • navicular
  • cuboid
  • cunieforms
37
Q

How can the tarsal bones become fractured?

A
  • twisting injury
38
Q

what does the management/treatment of tarsal bone fractures involve?

A
  • accurate reduction or orif
  • pop or ortho boot and NWB for 6-8 weeks
39
Q

which metatarsal bone is most commonly fractured?

A

the 5th metatarsal

40
Q

what type of fracture is a metatarsal normally?

A

stress fracture

41
Q

what kind of MOI does a metatarsal fracture involve?

A

inversion or PF injury

42
Q

what does a fracture of the metatarsal bones involve?

A
  • may or may not need ORIF
  • POP or orthoboot for 6 weeks
  • NWB
43
Q

through what MOI’s can a phalanges fracture occur?

A
  • falling object onto toes
  • industrial accidents
  • crush injury
44
Q

what does the management of phalanges fracture involve?

A
  • elevate to decrease swelling
  • strapping
  • may or may not need ORIF and k wiring
  • NWB or heel wb

NMSK1 - physio 1 (36 decks)

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