Ankle and foot injuries Flashcards
what cause ankle (soft tissue) sprains?
trauma
usually twisting forces (usually inversion/twisting forced on a planted foot)
high energy or osteoporotic bone
Elastic limit of ligaments - usually lateral ligaments (A/PTFL - anterior/posterior talofibular
ligaments, calcaneofibular ligaments CFL)
presentation of ankle sprian?
takes longer to resolve than a fracture pain bruising tenderness severity graded (1-3, 3 being complete rupture)
what is the management of an ankle sprain?
non-surgical: RICE (rest, ice, compression and elevation) physiotherapy surgical - Brostrum Gould - Chrisman Snook
What is the cause of ankle fracture?
common
usually a result of twisting forces (usually inversion or twisting on a planted foot)
what determines need for x-ray in ankle injury?
Ottawa criteria is used in A&E to determine whether an X-ray is needed:
severe localised
tenderness (bony tenderness) of the distal tibia/fibula, or inability to weight bear for four steps
what is the classification of ankle fractures?
weber classification
A - fracture of the lateral malleolus distal to the syndesmosis/tibial plafond (connection between the distal ends of the tibia and fibula) - usually stable
B - fracture at the level of the syndesmosis, can be stable or unstable (e.g. distal fibula fracture
WITHOUT medial malleolus fracture/deltoid ligament rupture would be stable, but WITH these
impairments it would be unstable)
C - fracture proximal to the level of the syndesmosis, usually unstable
• If unstable, need ORIF with plates and screws
what does talar shift/ tilt on AP x-ray mean?
deltoid ligament must be ruptured if there is no medial lammelar fracture
gross talar shift causes fracture-dislocation
what is the prognosis of talar shift?
Ankle joint contact pressures greatly increase with subsequent risk of post-traumatic OA whit
even 1mm of talar shift - SO anatomic reduction and rigid internal fixation is required to
minimise this risk with any taller shift
what is a bimalleolar ankle fracture?
(both medial and lateral malleoli fractured)
are unstable, usually do ORIF
(ORIF may be delayed by 1-2 weeks if there is associated soft tissue swelling and fracture
blisters, this is to reduce the risk of wound healing problems and infection)
what is a calcaneal fracture?
usually caused by fall from height onto heal
prognosis dependent on the extent of the involvement of the subtalar joint and the degree of comminution
what is a talar fracture?
usually because of forced dorsiflexion from rapid deceleration (RTA/ aircraft crash)
with dislocation/subluxation of the talus or displacement of the fracture
high risk of AVN
reduction
what is a midfoot (lisfranc) fracture/dislocation?
uncommon and often overlooked
Fracture of the base of the 2nd metatarsal is associated with the dislocation of the base of the
2nd metatarsal, with/without dislocation of the other metatarsals at the tarso-metatarsal joints
the ligament from the medial cuneiform to the base of the 2nd metatarsal not longer holds the
metatarsal in joint
what is the investigation of a midfoot (lisfranc) fracture/dislocation?
can be missed on x-ray
if in doubt CT
how does midfoot (lisfranc) fracture/ dislocation presenT?
grossly swollen
bruised foot
unable to weight bear (be wary if x-ray looks normal)
how is a midfoot (lisfranc) fracture/ dislocation managed?
closed/open reduction with fixation using screws
what is a 5th metatarsal fracture?
a fracture of the base of the 5th metatarsal
normally due to an inversion injury with an avulsion fracture at the insertion of the peroneus brevis tendon
how should 5th metatarsal fractures be managed?
heal - need walking cast/supportive bandage/ stout boot for 4-6 weeks
even if it fails to achieve bony union may have stable fibrous non-union (usually asymptomatic)
who gets 1st metatarsal fractures?
they are uncommon because it is strong and thick
important so normally fixed
what is a lesser metatarsal fracture?
common - often with multiple fractures
if minimal displacement then can be conservatively treated with a cast
if multiple displaced fractures - stabilised with K-wires to reduce the risk of chronic pain
what is a 2nd metatarsal fracture?
a common site for stress fracture
can occur spontaneously
or
after period of increased exercise/activity
how is a 2nd metatarsal fracture managed?
May not be seen on X-ray until healing/callus appears (can take several weeks)
Diagnosis: may use bone scan
Treatment: cast until pain subsides
what is the management for a toe fracture?
Rarely need anything except protection in a stout boot
Intra-articular fractures of the base of the proximal phalanx at the hallux: can do reduction and
fixation (if fragments are sizeable)
Open fractures: debridement, may be stabilised with wires• Dislocations: closed reduction and either neighbour strapping or wiring
