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T&O > Ankle & Foot > Flashcards

Ankle & Foot Flashcards

1
Q

What is comprised of in the ankle joint?

A

Talus bone which articulates with the mortise

Mortise is compromised of the tibial plafond and medial malleolus (distal end of tibia) and the lateral malleolus distal end of fibula)

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2
Q

What is the syndesmosis?

A

Very strong fibrous structure comprised of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL) and the intra-osseous membrane. This is where the distal fibula and tibia join.

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3
Q

What is an ankle fracture?

A

Fracture of any malleolus (lateral, medial or posterior, with or without disruption to the syndesmosis

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4
Q

What is the Weber classification?

A

Classifies lateral malleolus fractures

Type A - below syndesmosis
Type B - at the level of the syndesmosis
Type C - above the level of the syndesmosis

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5
Q

What type of ankle fractures need surgical fixation?

A

Type C - because higher the fracture the greater the probability of ankle instability

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6
Q

What classification is used more commonly used in orthopaedic practice?

A

Lauge-Hansen classification - based on position of ankle at time of injury and deforming force involved

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7
Q

What clinical features will someone with ankle fracture have?

A

Ankle pain following traumatic injury
Associated deformity - in fracture dislocations (urgent reduction required)

May have neurovascular compromise and often open fractures.

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8
Q

When are Ottawa ankle rules used and what are they?

A

Where there is diagnostic uncertainty e.g. able to mobilise and has no deformity

These state a plain radiograph should be undertaken if:

  • bone tenderness at the posterior edge or tip of the lateral malleolus
  • bone tenderness at the posterior edge or tip of medial malleolus
  • an inability to weight bear both immediately and in the emergency department for 4 steps
  • pain in fibula, base of 5th metatarsal or/and dorsal mid foot
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9
Q

What investigations should be done for ankle fractures?

A

X-ray - AP and lateral of the ankle
Check for Talar shift

May require CT - if complex esp when displaced posterior malleolus fragment

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10
Q

How are ankle fractures classified anatomically?

A

Isolated medial malleolar fractures
Isolated lateral malleolar fractures
Bimalleolar fractures
Trimalleolar fractures

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11
Q

What is the initial management for ankle fractures?

A

Immediate fracture reduction under sedation to realign the fracture.
Once reduced ankle should be placed in a below knew back slab
Repeat neurovascular examination

May require repeat x-rays if reduction not adequate

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12
Q

When is conservative management opted for in ankle fractures?

A
  • Non-displaced medial malleolus fractures
  • Weber A fractures or Weber B without talar shift
  • Unfit for surgery
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13
Q

What is the surgical intervention for ankle fractures?

A

Open reduction and internal fixation (ORIF)

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14
Q

Which ankle fractures require surgical management?

A
  • Displaced bimalleolar or trimalleolar
  • Weber C fractures
  • Weber B fractures with talar shift
  • Open fractures
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15
Q

What are the complications of ankle fractures?

A

Post traumatic arthritis

ORIF:

  • infection
  • DVT/PE
  • neurovascular injury
  • non-union
  • metalwork prominence
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16
Q

What is the main differential diagnosis for ankle fractures?

A

Ankle sprain

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17
Q

What are ankle sprain and what are the two types?

A

Ligamentous injury

High ankle sprain - syndesmosis
Low ankle sprain - anterior talofibular ligament (ATFL), calcaeofibular ligament (CFL) latter more common

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18
Q

What is the usual mechanism of injury in an ankle sprain?

A

Inversion injury on a planterflexed ankle

19
Q

What are the clinical findings of ankle sprain?

A

Swelling and pain - potentially not being able to weight bear
Fingertip tenderness distal to the malleoli

20
Q

What is the investigation and management of ankle sprains?

A

X-ray - rule out bony injury

Managed conservatively - analgesia and RICE and early mobilisation

21
Q

Which people is Achilles tendinitis more prevalent?

A

People who engage in high-intensity activities and chronically overload the tendon

22
Q

What can occur as a result of Achilles tendinitis?

A

Achilles’ tendon rupture

23
Q

What are the risk factors for Achilles tendinitis?

A 
Unfit individual with sudden increase in exercise freq
Poor footwear 
Male gender 
Obesity
Fluoroquinolone use
24
Q

What is the presentation of Achilles tendinitis?

A

Gradual onset of pain and stiffness in the posterior ankle often worse with movement. Improved my mild exercise or heat application.

Tenderness on palpation

25
Q

What is the test for an Achilles rupture?

A

Simmonds test

26
Q

What are the main differentials for Achilles tendinitis?

A

Ankle sprain
Stress fracture
OA

27
Q

What investigation can be performed if there is uncertainty of diagnosis in Achilles tendinitis/rupture?

A

Ultrasound

28
Q

What is the management for Achilles tendinitis?

A

RICE
Anti - inflammatory medication regularly

Chronic cases require- rehab and physio

29
Q

What is the management for Achilles’ tendon rupture?

A

Analgesia and immobilisation with ankle splinting in a plaster in full equinus. Crutches and not allowed to weight bear. - 2 weeks

Then semi-equinus for further 4 weeks and the neutral for another 4 weeks

Delayed presentation of >2weeks and re rupture requires surgical fixation with end-to-end tendon repair.

30
Q

What is hallux valgus?

A

Medial deviation of the first metatarsal and lateral deviation +/- rotation of the hallux with associated joint subluxation

31
Q

What are the risk factors for developing hallux valgus?

A

Female
Connective tissue disorders
Hyper mobility syndromes

Anatomical variants e.g. flat feet

32
Q

How does hallux valgus typically present?

A

Painful medial prominence - present for long period of time before increasing in freq/intensity

33
Q

What signs may be present in the examination of hallus valgus?

A

Examination lateral deviation of hallux - evidence of inflammation and skin breakdown over prominence- assess both in non-weight bearing and weight bearing foot

Contracture of the extensor hallux tendon may be visible in long standing joint subluxation and any excessive keratosis

34
Q

What are the differential diagnosis for hallux valgus?

A 
Gout 
Septic arthritis 
Hallux rigidus
OA
RA
35
Q

What investigation would you do for hallux valgus?

A

X-ray - measure angle of lateral deviation and signs of subluxation

Mild - 15-20 degrees
Moderate - 21-39
Severe - >40 degrees

36
Q

What is the initial management of hallux valgus?

A

Sufficient analgesia
Adjusting footwear - if flat feet may need orthosis
Physio

37
Q

What are the surgical options for hallux valgus?

A

Offered in quality of life significantly affected :

  • Chevron procedure
  • Scarf procedure
  • Lepidus procedure
  • Keller procedure
38
Q

What are the surgical complications for hallux valgus?

A 
Wound infection 
Delayed healing 
Nerve injury 
Osteomyelitis 
Recurrence
39
Q

What are complications of hallux valgus?

A

Avascular necroisis
Non-union
Displacement
Reduced ROM

40
Q

What are some associated injuries with ankle fractures?

A

Proximal fibula fracture - maisonneuve fracture

Base of 5th metatarsal - dancers fracture

41
Q

When would you use an external fixation for ankle fractures?

A

When there is soft tissue compromise/swelling

You would elevate limb, non-weight bearing and delay surgery

42
Q

What do you look for to assess the mortice joint?

A

Medial clear space (>4mm)
Concurgency of the joint
Overlap between then the fibula and tibia (>1mm)
Fibula shortening

43
Q

What should be done if a posterior malleolus fracture of the ankle is suspected?

A

CT scan should be ordered and it should be assumed that the posterior inferior tibiofibular ligament is damaged

This requires fixation

44
Q

What should be done in a pt with multiple co-morbities including diabetes that has a unstable ankle fracture and are unfit or surgery?

A

Semi-stable - cast and monitor

Unstable - hind foot nailing is an option - but can risk other fractures esp in osteoporotic bones

T&O (13 decks)

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