Ankle Fracture Flashcards

1
Q

Questions to ask for ankle injury

A
  • Onset
  • Location of pain
  • Activity at the time
  • Weight bearing?
  • ROM
  • Previous ankle injuries/problems
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2
Q

Examination things to look for for ankle #

A
  • Deformity - higher risk of NV compromise
  • Open # - needs debridement and irrigation
  • Check Ottawa rules if unsure
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3
Q

What are the Ottawa rules for ankle pain?

A

Apply if uncertain - eg if patient can mobilise and has no deformity.
X-rays should be taken if any of following apply:
* Bone tenderness at posterior edge or tip of lateral malleolus OR
* Bone tenderness at posterior edge or tip of medial malleolus OR
* Inability to weight bear immediately and in emergency department for 4 steps

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4
Q

Investigations for suspected ankle #

A
  • X-ray - AP lateral and mortise view. Ankle needs to be fully dorsiflexed
  • CT if complex or posterior malleolus displaced

DorSI to SEE

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5
Q

Emergency treatment for ankle # in ED

A
  • Immediate reduction of fracture under sedation
  • Allows realignment
  • Stabilise with below knee back slab
  • Document post reduction NV status of limb
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6
Q

How do you check if reduction was adequate?

A
  • Repeat x-ray, if inadequate realignment, repeat
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7
Q

When would patient have surgery for fracture of ankle?

A
  • Displaced bimalleolar or trimalleolar fracture
  • Weber class C
  • Weber class B with talar shift
  • Open fractures
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8
Q

Classification of ankle fractures

A
  • Weber classification - if lateral malleolus
  • Lauge Hansen classification - based on ankle position at time of injury, deforming force, much more detailed than Weber

Helly Hansen sounds like wellies - go over ankle

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9
Q

Weber classifcation of fractures

A

Class A, B and C
More proximal = higher risk of instability
= C often surgically fixation managed

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10
Q

Walking aids given for patient following internal fixation of ankle joint

A
  • Under arm crutches
  • Zimmer frame
  • Orthopedic boot
  • Knee scooter
  • Wheelchair
  • Assistance for home eg handrails etc
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11
Q

How long before can work and do sport post internal fixation of ankle?

A
  • Work - depends on job
  • Sport - 6 weeks of boot, then gradual physio out of boot, standard time is 12 weeks post surgery
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12
Q

When is conservative management used in ankle #? (post reduction)

A
  • Non-displaced medial malleolus #
  • Weber A (all) or Weber B fractures without talar shift
  • Those unfit for surgical intervention
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13
Q

Complications post ankle #

A
  • Post traumatic arthirtis - rare with adequate treatment of reduction and fixation
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14
Q

Anatomical classification of ankle #

A
  • Lateral malleolus
  • Medial malleolus
  • Bimalleolar
  • Trimalleolar
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15
Q

What keeps ankle joint stable usually?

A
  • Interosseus membrane between tibia and fibula
  • Anterior inferior tibiofibular ligament
  • Posterior inferior tibiofibular ligament

PITFL - pitfall

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16
Q

Normal ankle anatomy

A
17
Q
A