Ankle And Foot Injuries Flashcards
What is a maisonneuve fracture?
External rotational force on the ankle that causes damage up the leg as it twists
Aka fibulotibialis ligament tear
What are the 3 elements of a maisonneuve fracture?
- Deltoid ligament rupture or medial malleolus injury
- Tear in interosseus membrane
- Proximal fibula fracture
What is the clinical presentation of a masionneuve fracture?
Suspect if you find:
- TTP at fibular head or proximal fibular shaft (leg squeeze test)
- significant medial malleolus tenderness and swelling
- negative radiographs (suggest syndesmosis tear)
Imaging if you suspect maisonneuve fracture
Fibular radiograph
Management of maisonneuve fracture ?
Surgery
- reduce and stabilize the fractured medial malleolus
- secure the fibula to the distal tibia
- allows the interosseous membrane to heal
Evaluation of an achilles injury
Exam:
- palpable defect in the tendon 2-6cm from the calcaneous
- maybe calf swelling
- unable to stand on toes
- thompsons test
Why does the thompson test work (Achilles injury)
If the achilles tendon is ruptured, the foot witll not plantar-flex when the calf is squeezed
Imaging for achilles tendon injury
POCUS is first line
Obtain MRI if dx is not clear
Range of lisfranc injuries
Sprains to fracture-dislocations
- concurrent fractures of the hindfoot and forefoot are common
- especially fracture of the second metatarsal
MOI for lisfranc injury
Sprain: low veloicty indirect force
Fracture: plantarflexion with axial load
- strenuous jumping over an obstacle
- usually sports or MVC
If you have a metatarsal fracture you need to?
Assess for lisranc injury
When to suspect lisfranc injury?
- significant pain with torsion of midfoot
- pain in passive dorsiflexion
- pain in plantarflexion of the foot
- ottawa ankle rules
Imaging for suspected lisfranc injury
Bilateral weight bearing A/P, lateral and 30-degree oblique views for the foot
- CT if xr is equivocal
What xr findings show an unstable lisfranc injury?
Bony displacement 1mm or greater between the bases of the 1st and 2nd metatarsal
What is the nunley classification system?
A rule to group low-energy ligamentous injury by:
- diastasis and
- preservation or loss of arch height
Nunley classification types (lisfranc)
Type I: non-displaced
Type II: involve diastasis between 1st and 2nd metatarsal heads
Type III: diastases with loss of arch height
Definition of diastasis
Separation of bones that are normally attached
Who do ottawa ankle rules apply to?
Age >18
Not intoxicated
No distracting injuries
No Decreased sensation
There are separate rules for children
What are the ottawa foot and ankle rules?
Images required for pain in the malleolar zone or mid foot AND bony tenderness to the:
- posterior edge/tip of the lateral or medial malleolus
- navicular
- Base of the 5th metatarsal
Or unable to bear weight both at time of injury and in the ED
Navicular fracture goal of treatment
Maintain the anatomy and restoration of articular congruity.
- the central part of the navicular is avalscular
Complications of navicular fracture
Avascular necrosis
Nonunion
Instability
All can lead to flat foot deformities
How to manage navicular fractures?
Non-displaced: non-weightbearing short leg cast for 6-8 wks
- orthopedic reeval in 2 wks
Displaced (unstable):
- orthopedic evaluation in ED
