ankle and foot fractures Flashcards
what can cause a fibula fracture?
- direct trauma to the outer leg - transverse or comminuted fracture
- twisting injury - spiral fracture
- repeated stress - fatigue fracture
what is noticed upon the initial examination of a fibula fracture?
- tender
- bruisng
- painful and restricted ROM
- limited WB
what does the treatment of a fibula fracture involve?
- 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
what are the causes of a fracture of the tibia?
- 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
how would an undisplaced tibial fracture be managed?
- 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
how is a displaced tibial fracture managed?
- 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
what % of tibial fractures are associated with fibial fractures?
30%
does the fibula usually require fixation?
no
what are the **complications **of a tibial fracture?
- soft tissue damage
- ulceration
- skin loss if open fracture
- nerve damage
- vascular damage
- non union
- delayed union
- instability
what is compartment syndrome?
- a condition in which the pressure in the muscles is dangerouly raised - higher than arterial and venous pressure
- treated with fasciotomy - to decrease pressure
what is the normal resting pressure compared to an abnormal pressure (as seen in compartment syndrome) of the lower leg?
- normal pressure - 0-8mmHg
- abnormal pressure - 30mmhg - requires fasciotomy
what are important preventative measures of compartment syndrome?
monitoring
* pulse
* colour
* temperature
* neuropathic changes
to ensure cs is not developing
what are the symptoms of compartment syndrome?
- abnormal amount of pain
- swelling
- numbess
- paraesthesia - abnormal sensation eg prickling/tingling etc
- painful ROM
what can cause compartment syndrome of the lower leg?
after fractures
in which fracture is a fat embolism common after?
shaft of tibia or femur
what can ankle fractures be associated with?
ligament damage
what are the types of ankle fractures?
- isolated medial malleolar
- isolated lateral malleolar
- bimalleolar
- trimalleolar
- pilon fracture - high trauma fracture of tibia - happens near ankle
what is a danis weber type a lateral malleolar fracture?
- below level of ankle joint
- tibiofibular syndesmosis intact
- deltoid ligament intact
- medial malleolus often fractured
- usually stable
describe a danis weber type B lateral malleolar fracture
- at the level of the ankle joint
- syndesmosis intact or partially torn
- medial malleolus may be fractured
- deltoid ligament may be torn
- variable stability
describe a danis weber type C lateral malleolar fracture
- above the level of the ankle joint
- dyndesmosis disrupted
- medial malleolus fracture
- delotoid ligament injury
- unstabke - requires ORIF
what is a very common MOI for a lateral malleous fracture?
- supination -external rotation
- SER
what is diastasis?
what is it, MOI, management
- disrupted / seperated inferior tib-fib joint (syndesmosis)
- caused by severe external rotation force
- requires ORIF for 8 weeks and cast/boot for ligament healing
what are the ottawa ankle rules?
- 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
what are the aims of treatment for an ankle fracture?
- restore and maintain normal alignment of the talus and tibia
- ensure optimal restoration of the articulating surfaces to reduce later risk of OA
how is a undisplaced ankle fracture managed?
- ortho boot cast for 8 weeks
- limited wb
how is a displaced ankle fracture managed?
- restore shape of joint
- ORIF
- ortho boot for 8 weeks
what does the physiotherapy treatment of an ankle fracture involve once the cast is removed?
- 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
what bones can be fractured in the foot?
- talus
- calcaneus
- tarsal bone
- metatarsal
- phalangeal
what can cause a talus fracture?
- twisting injury or violent dorsiflexion
- can happen to the body or neck of the talus
- classified by hawkins type i-iv
how is a displaced vs non displaced talus fracture managed?
- no displacement - NWB and pop below knee for 6-8 weeks
- displaced - ORIF and pop below knee & NWB for 6-8 weeks
what are the complications of a talus fracture?
- skin damage at time of injury
- non union
- AVN
- OA
What can cause a fracture of the calcenous bone?
- fall from a height
- landing on heel
what is commonly noticed with the fracture of the calcenous bone?
- avulsion of the posterior segment of achilles tendon
- fracture of the sustentaculum tali
- burst compression fracture
- comminuted fractures
compare the conservative vs surgical management of a calcaneus fracture?
- conservative
* rest and POP - NWB gait for 6 weeks - surgical
* ORIF
* POP or ortho boot NWB for 6-8 weeks
what does the physio management post op involve for a calcaneous fracture?
- gait re-education
- advice for footwear for painful heel
- orthotics?
what tarsak bones can be fractured?
- navicular
- cuboid
- cunieforms
How can the tarsal bones become fractured?
- twisting injury
what does the management/treatment of tarsal bone fractures involve?
- accurate reduction or orif
- pop or ortho boot and NWB for 6-8 weeks
which metatarsal bone is most commonly fractured?
the 5th metatarsal
what type of fracture is a metatarsal normally?
stress fracture
what kind of MOI does a metatarsal fracture involve?
inversion or PF injury
what does a fracture of the metatarsal bones involve?
- may or may not need ORIF
- POP or orthoboot for 6 weeks
- NWB
through what MOI’s can a phalanges fracture occur?
- falling object onto toes
- industrial accidents
- crush injury
what does the management of phalanges fracture involve?
- elevate to decrease swelling
- strapping
- may or may not need ORIF and k wiring
- NWB or heel wb
