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Orthobullets Trauma > Ankle Fractures > Flashcards

Ankle Fractures Flashcards

1
Q

age distribution of ankle fractures

A

bimodal: young, active male 15-24 and elderly females 75-84

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2
Q

percentage of each fracture type:

A

70% isolated malleolus fx
20% bimalleolar
7% trimalleolar

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3
Q

what type of ankle fractures are most common?

A

isolated malleolus

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4
Q

risk factors for ankle fractures

A

male
younger age
obesity
smoking
alcohol consumption

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5
Q

mechanism of injury most common

A

twisting injury

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6
Q

associated injuries

A

open fractures
syndesmotic injury
chondral injury
peroneal tendon tears

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7
Q

most common associated injury

A

syndesmotic injury

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8
Q

osteology of the ankle

A

modified hinge joint consisting of tibia, fibula, and talus

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9
Q

3 ligamentous complexes that stabilize the ankle

A

deltoid
lateral ligament complex
syndesmosis

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10
Q

deltoid two components

A

superficial & deep

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11
Q

superficial deltoid component extends from______

A

medial malleolus to broad insertion onto navicular, sutentaculum tali, and talus

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12
Q

extends from medial malleolus to broad insertion onto navicular, sutentaculum tali, and talus

A

superficial deltoid

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13
Q

deep deltoid extends from_____

A

medial malleolus to talus

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14
Q

extends from medial malleolus to talus

A

deep deltoid

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15
Q

resists hind foot eversion

A

superficial deltoid

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16
Q

superficial deltoid resists what motion

A

hindfoot eversion

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17
Q

deep deltoid resists what motion

A

ER of talus

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18
Q

resists ER of talus

A

deep deltoid

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19
Q

lateral ligament complex 3 components

A

anterior talofibular ligament (ATFL)
calcaneofibular ligament (CFL)
posterior talofibular ligament (PTFL)

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20
Q

anterior talofibular ligament (ATFL)
calcaneofibular ligament (CFL)
posterior talofibular ligament (PTFL)

A

lateral ligament complex

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21
Q

primary restraint to anterior displacement, IR, and inversion of talus

A

anterior talofibular ligament (ATFL)

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22
Q

most frequently injured ligament

A

anterior talofibular ligament (ATFL)

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23
Q

the ATFL is the primary restraint to ____

A

anterior displacement, IR, and inversion of talus

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24
Q

calcaneofibular ligament is deep to ______ tendons

A

peroneal

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25
Q

2nd most commonly injured ligament

A

calcaneofibular ligament (CFL)

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26
Q

deep to peroneal tendons

A

calcaneofibular ligament (CFL)

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27
Q

strongest ligament of lateral complex

A

posterior talofibular ligament (PTFL)

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28
Q

least likely ligament to be disrupted

A

posterior talofibular ligament (PTFL)

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29
Q

5 components of the syndesmosis

A

anterior inferior tibiofibular ligament (AITFL)
posterior inferior tibiofibular ligament (PITFL)
intraosseous ligament (IOL)
intraosseous membrane
inferior transverse ligament (ITL)

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30
Q

originates from anterolateral tubercle of distal tibia

A

anterior inferior tibiofibular ligament (AITFL)

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31
Q

inserts anteriorly onto lateral malleolus

A

anterior inferior tibiofibular ligament (AITFL)

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32
Q

anterior inferior tibiofibular ligament (AITFL) originates from

A

anterolateral tubercle of distal tibia

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33
Q

anterior inferior tibiofibular ligament (AITFL) inserts anteriorly onto

A

lateral malleolus

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34
Q

broad origin from posterior tibia

A

posterior inferior tibiofibular ligament (PITFL)

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35
Q

inserts onto posterior aspect of lateral malleolus

A

posterior inferior tibiofibular ligament (PITFL)

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36
Q

strongest component of syndesmosis

A

posterior inferior tibiofibular ligament (PITFL)

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37
Q

posterior inferior tibiofibular ligament (PITFL) has broad origin from

A

posterior tibia

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38
Q

posterior inferior tibiofibular ligament (PITFL) inserts onto

A

posterior aspect of lateral malleolus

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39
Q

distal continuation of interosseous membrane

A

intraosseous ligament

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40
Q

what neurovascular structures are at risk with anterior approach to the ankle

A

anterior tibial artery and deep peroneal nerve

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41
Q

anterior tibial artery and deep peroneal nerve are at risk with what approach

A

anterior

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42
Q

course over anterior ankle between EDL and EHL

A

anterior tibial artery and deep peroneal nerve

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43
Q

anterior tibial artery and deep peroneal nerve course over

A

anterior ankle between EDL and EHL

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44
Q

posterior tibial artery and tibial nerve course posterior to

A

medial malleolus between FDL and FHL

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45
Q

posterior tibial artery and tibial nerve at risk with what approach

A

posteromedial approach

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46
Q

course posterior to medial malleolus between FDL and FHL

A

posterior tibial artery and tibial nerve

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47
Q

at risk with posteromedial approach

A

posterior tibial artery and tibial nerve

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48
Q

superficial peroneal nerve crosses anteriorly over

A

fibula about distal 1/3

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49
Q

superficial peroneal nerve at risk with what approaches

A

posterolateral
direct lateral
anterior/anterolateral

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50
Q

crosses anteriorly over fibula about distal 1/3

A

superficial peroneal nerve

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51
Q

at risk with posterolateral, direct lateral, anterior/anterolateral approaches

A

superficial peroneal nerve

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52
Q

sural nerve at risk with what approaches

A

posterolateral and direct approach to fibula

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53
Q

at risk with posterolateral and direct approach to fibula

A

sural nerve

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54
Q

acts as buttress to prevent lateral displacement of talus

A

fibula

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55
Q

the fibula acts a buttress to prevent what

A

lateral displacement of talus

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56
Q

dorsiflexion results in what motion of the fibula

A

ER and lateral translation

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57
Q

plantar flexion results in narrower, posterior aspect of the talus leading to ____

A

IR of talus

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58
Q

_____ results in narrower, posterior aspect of the talus leading to IR of the talus

A

plantarflexion

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59
Q

_____ results in fibula ER and lateral translation, accommodating anteriorly wider talus

A

dorsiflexion

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60
Q

classification of ankle fractures

A

lauge-hansen

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61
Q

classification for the location of fibular fractures

A

danis-weber

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62
Q

what is a supination-adduction ankle fracture

A
  1. talofibular sprain or distal fibular avulsion
  2. vertical medial malleolus and impaction of anteromedial distal tibia
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63
Q
  1. talofibular sprain or distal fibular avulsion
  2. vertical medial malleolus and impaction of anteromedial distal tibia
A

supination-adduction

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64
Q
  1. anterior tibiofibular ligament sprain
  2. lateral short oblique fibula fracture
  3. posterior tibiofibular ligament rupture or avulsion of posterior malleolus
  4. medial malleolus transverse fracture or disruption of deltoid ligament
A

supination-external rotation

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65
Q

supination-external rotation type

A
  1. anterior tibiofibular ligament sprain
  2. lateral short oblique fibula fracture
  3. posterior tibiofibular ligament rupture or avulsion of posterior malleolus
  4. medial malleolus transverse fracture or disruption of deltoid ligament
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66
Q
  1. medial malleolus transverse fracture or disruption of deltoid ligament
  2. anterior tibiofibular ligament sprain
  3. transverse comminuted fracture of the fibula above the level of the syndesmosis
A

pronation-abduction

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67
Q

pronation-abduction type

A
  1. medial malleolus transverse fracture or disruption of deltoid ligament
  2. anterior tibiofibular ligament sprain
  3. transverse comminuted fracture of the fibula above the level of the syndesmosis
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68
Q
  1. medial malleolus transverse fracture or disruption of deltoid ligament
  2. anterior tibiofibular ligament disruption
  3. lateral short oblique or spiral fracture of fibula
  4. posterior tibiofibular ligament rupture or avulsion of posterior malleolus
A

pronation-external rotation

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69
Q

pronation-external rotation type=

A
  1. medial malleolus transverse fracture or disruption of deltoid ligament
  2. anterior tibiofibular ligament disruption
  3. lateral short oblique or spiral fracture of fibula
  4. posterior tibiofibular ligament rupture or avulsion of posterior malleolus
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70
Q

Danis-weber type A=

A

infrasyndesmotic

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71
Q

Danis weber type B=

A

transsyndesmotic

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72
Q

Danis weber type C=

A

suprasyndesmotic

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73
Q

curbstone fracture=

A

avulsion fracture of posterior tibia resulting from tripping

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74
Q

avulsion fracture of posterior tibia resulting from tripping

A

curbstone fracture

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75
Q

AITFL avulsion off anterior fibular tubercle usually seen with SER-type fracture patterns

A

LeFort-Wagstaffe fracture

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76
Q

LeFort-Wagstaffe fracture

A

AITFL avulsion off anterior fibular tubercle usually seen with SER-type fracture patterns

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76
Q

AITFL avulsion of anterior tibial margin

A

Tillaux-Chaput fracture

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77
Q

Tillaux-Chaput fracture

A

AITFL avulsion of anterior tibial margin

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78
Q

on exam, palpate proximal fibula for ____

A

Maisonneuve fracture

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79
Q

physical exam:

A

ecchymosis and swelling around the ankle
deformity
soft tissue assessment

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80
Q

recommended Xray views

A

ankle series-AP, lateral, mortise
dynamic stress views
full length tibia radiographs

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81
Q

manual stress view is the most appropriate stress radiograph to assess competency of _____

A

deltoid ligament

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82
Q

Xray findings indicative of syndesmotic injury

A

decreased tibiofibular overlap
increased medial clear space
increased tibiofibular clear space

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83
Q

decreased tibiofibular overlap
increased medial clear space
increased tibiofibular clear space

A

syndesmotic injury

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84
Q

normal tibiofibular overlap on AP

A

> 6 mm

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85
Q

medial clear space of >______ mm with external rotation stress applied to a dorsiflexed ankle is predictive of deep deltoid disruption

A

5

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85
Q

normal tibiofibular overlap on mortise view

A

> 1 mm

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85
Q

medial clear space of >5 mm with external rotation stress applied to a dorsiflexed ankle is predictive of____

A

deep deltoid disruption

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85
Q

normal medial clear space on mortise or stress view

A

<4 mm

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86
Q

normal tibiofibular clear space on both AP and mortise views

A

<6 mm

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87
Q

bisection of line through tibial anatomical axis and line through tip of both malleoli

A

talocrural angle

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88
Q

talocrural angle=

A

bisection of line through tibial anatomical axis and line through tip of both malleoli

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89
Q

shortening of lateral malleoli fractures can lead to increased ____

A

talocrural angle

90
Q

double contour sign
misty mountains sign
spur sign

A

posterior malleolus fracture

91
Q

signs suggestive of posterior malleolus fracture

A

double contour sign
misty mountains sign
spur sign

92
Q

CT indications

A

trimalleolar fracture operative planning
assess morphology of posterior malleolus
supination adduction injury

93
Q

most useful CT views to assess posterior malleolus

A

axial and sagittal views

94
Q

CT findings

A

size and shape of posterior malleolus fragment
entrapped loose fragments
impaction
comminution

95
Q

MRI indications

A

evaluate soft tissue or cartilaginous injuries

96
Q

MRI findings

A

deltoid injury
syndesmotic injury
lateral ankle ligament complex
peroneal tendon injury
chondral lesions of talus

97
Q

may be able to bear weight
positive anterior drawer or talar tilt test
XR shows no fracture

A

ankle sprain

98
Q

positive Hopkin’s squeeze test
increased medial clear space or tibiofibular diastases on stress view

A

syndesmotic injury

99
Q

palpable gap over achilles
inability or weakness with plantar flexion
increased resting dorsiflexion when prone with knees bent
positive Thompsons test

A

achilles tendon rupture

100
Q

high energy, axial load
significant articular involvement
chaput fragment, volkmann fragment, medial malleolus, central impaction

A

pilon fracture

101
Q

high energy with extensive soft tissue injury
XR shows dislocation of talus from calcaneus or navicular bone

A

subtalar dislocation

102
Q

indications for nonoperative treatment

A

stable ankle fracture
isolated stable medial malleolus fracture
isolated stable lateral malleolus fracture
avulsion tip fractures of medial or lateral malleolus
posterior malleolar fracture with < 25% joint involvement or < 2mm step-off
unfit for surgery

103
Q

stable ankle fracture op or non op?

A

non op

104
Q

isolated stable medial mall op or non op?

A

non op

105
Q

isolated stable lateral mall op or non op?

A

non op

106
Q

avulsion tip fractures of medial or lateral malleolus op or non op?

A

non op

107
Q

posterior malleolar fracture with < 25% joint involvement or < 2mm step-off op or non op?

A

non op

108
Q

non op modalities:

A

CAM boot
short leg splint
short leg cast

109
Q

ORIF indications

A

any talar displacement
bimalleolar or bimalleolar-equivalent fracture
posterior malleolar fracture with > 25% or > 2mm step-off
Maisonneuve fracture
Bosworth fracture-dislocations
open fractures
symptomatic malleolar nonunions

110
Q

any ____ displacement -> ORIF

A

talar

111
Q

bimalleolar or bimalleolar-equivalent fracture op or non op?

A

op

112
Q

posterior malleolar fracture with > 25% or > 2mm step-off op or non op?

A

op

113
Q

Maisonneuve fracture op or non op?

A

op

114
Q

Bosworth fracture-dislocations op or non op?

A

op

115
Q

open fractures op or non op?

A

op

116
Q

symptomatic malleolar nonunions op or non op?

A

op

117
Q

goal of treatment is stable anatomic reduction with restoration of ______

A

mortise

118
Q

approach options

A

direct lateral
posterolateral
posteromedial
direct medial

119
Q

direct lateral approach ->

A

common approach for fibula ORIF syndesmotic fixation
syndesmotic fixation

120
Q

common approach for fibula ORIF syndesmotic fixation
syndesmotic fixation

A

direct lateral approach

121
Q

posterolateral approach ->

A

concomitant access to posterior fibula and posterior malleolus
prone or lateral

122
Q

concomitant access to posterior fibula and posterior malleolus
prone or lateral

A

posterolateral approach

123
Q

access to medial malleolus and posterior malleolus

A

posteromedial approach

124
Q

common approach for medial malleolus ORIF

A

direct medial approach

125
Q

considered most important factor for satisfactory outcome

A

anatomic reduction

126
Q

1 mm shift of talus leads to ____% decrease in tibiotalar contact area

A

42

127
Q

______ mm shift of talus leads to 42% decrease in tibiotalar contact area

A

1

128
Q

worse outcomes associated with:

A

decreased level of education
smoking
alcohol use
presence of medial malleolar fracture

129
Q

restoration of ______ in SA ankle fracture leads to optimal functional outcomes

A

marginal impaction of tibial plafond

130
Q

improved incisional perfusion with _______ sutures

A

Allgöwer-Donati

131
Q

proper braking response time (driving) returns to baseline at _____ weeks after surgery

A

9

132
Q

braking travel time is significantly increased until _____ weeks after initiation of weight bearing in both long bone and periarticular fractures of lower extremity

A

6

133
Q

indications for ex fix

A

severe open fractures with gross contamination
poor soft tissue requiring close monitoring
unstable reduction

134
Q

ex fix has lower risk of ______ versus a splint

A

redislocation and skin complication

135
Q

non op indications for isolated medial mall fracture

A

isolated medial malleolus fracture without talar shift
avulsion tip fracture

136
Q

non op technique for isolated medial mall fracture

A

NWB for 4-6 weeks

137
Q

outcomes of isolated medial mall fracture non op treatment

A

good outcomes with >95% union rate for isolated injury

138
Q

indications for ORIF of isolated medial mall fx

A

any talar shift

139
Q

ORIF techniques for isolated medial mall fx

A

lag screw
antiglide plate with lag screw
tension band fixation

140
Q

lag screw fixation stronger if placed _____

A

perpendicular to fracture line

141
Q

antiglide plate with lag screw
best for ______ isolated medial mall fractures

A

vertical shear

142
Q

tension band fixation for isolated medial mall is useful when

A

fragment too small
poor bone quality

143
Q

non op indications of isolated lateral mall

A

stable mortise with no talar shift

144
Q

> ______mm of medial clear space widening on stress views considered unstable in isolated lateral mall fx

A

4-5

145
Q

isolated lateral mall non op techniques

A

immediate WBAT in CAM boot
brief period of immobilization in splint

146
Q

ORIF indications of isolated lateral mall fracture

A

presence of talar shift on static or stress view (bimalleolar equivalent)
>3 mm displacement

147
Q

isolated lateral mall ORIF techniques

A

plate
retrograde intramedullary fixation

148
Q

stiffest fixation construct for the fibula is a ____ plate

A

locking

149
Q

one-third tubular or anatomic distal fibular plate
stiffest fixation construct for the fibula is a locking plate

A

lateral plate

150
Q

one-third tubular plate (antiglide mode)
posterior antiglide plating is biomechanically superior to lateral plate
disadvantage of peroneal tendon irritation if plate too distal

A

posterolateral plate

151
Q

when is retrograde intramedullary nailing of isolated lateral mall useful

A

poor soft-tissue envelopes or high risk for wound-healing complication

152
Q

what is a bimalleolar equivalent?

A

DELTOID LIGAMENT TEAR WITH FIBULAR FRACTURE

153
Q

bimalleolar fracture non op indications

A

low demand and unable to undergo surgical intervention

154
Q

ORIF indications in bimalleolar fractures

A

any displacement or talar shift (static or stress view)

155
Q

bimalleolar ORIF fibular techniques

A

lateral plate
posterolateral plate
retrograde intramedullary fixation

156
Q

bimalleolar fracture medial mall techniques

A

antiglide plate
tension band wiring
lag screws

157
Q

posterior malleolus fracture non op indications

A

< 25% of articular surface involved
size should be calculated on CT since plain radiographs are unreliable
< 2 mm articular stepoff
stable syndesmosis

158
Q

ORIF indications of posterior malleolus fracture

A

> 25% of articular surface
2 mm articular stepoff
syndesmotic instability
posterior subluxation of talus

159
Q

ORIF posterior mall approaches

A

posteromedial
posterolateral
percutaneous

160
Q

interval for posterolateral approach to isolated medial mall

A

between FHL and peroneal tendons

161
Q

posterior malleolus fixation methods

A

antiglide plate
percutaneous A to P lag screws

162
Q

stiffness of syndesmosis restored to ________% normal with isolated fixation of posterior malleolus vs 40% with isolated syndesmosis fixation

A

70

163
Q

_____ may remain attached to posterior malleolus and syndesmotic stability may be restored with isolated posterior malleolar fixation

A

PITFL

164
Q

stress examination of _______ still required after posterior malleolar fixation

A

syndesmosis

165
Q

40-90% of distal third spiral tibia fractures have an associated ______ fracture

A

posterior malleolus

166
Q

40-90% of _______ fractures have an associated posterior malleolus fracture

A

distal third spiral tibia

167
Q

rare fracture-dislocation of ankle where fibula is entrapped behind tibia and is irreducible

A

Bosworth fracture dislocation

168
Q

what is a Bosworth fracture

A

rare fracture-dislocation of ankle where fibula is entrapped behind tibia and is irreducible

169
Q

Bosworth fracture treatment

A

ORIF

170
Q

posterolateral ridge of the distal tibia hinders reduction of the fibula

A

Bosworth fracture dislocation

171
Q

fracture-dislocation of the ankle due to hyperplantarflexion

A

hyperplantarflexion variant

172
Q

main feature is a vertical shear fracture of the posteromedial tibial rim

A

hyperplantarflexion variant

173
Q

hyperplantarflexion variant main feature

A

vertical shear fracture of the posteromedial tibial rim

174
Q

“spur sign” is pathognomonic

A

hyperplantarflexion variant

175
Q

hyperplantarflexion variant pathognomonic feature

A

spur sign

176
Q

double cortical density at the inferomedial tibial metaphysis

A

spur sign

177
Q

what is the spur sign?

A

double cortical density at the inferomedial tibial metaphysis

178
Q

hyperplantarflexion variant treatment

A

ORIF of posterior malleolus with antiglide plating

179
Q

open ankle fracture operative options

A

emergent operative debridement and ORIF
ex fix

180
Q

open ankle fracture ex fix indications

A

significant soft tissue compromise
unstable fracture in splint/cast

181
Q

_____% of all ankle fractures have associated syndesmotic injury

A

10%

182
Q

higher incidence with higher fibula fractures

A

syndesmotic injury

183
Q

syndesmotic injury higher incidence with _____ fractures

A

higher fibula

184
Q

fixation of associated syndesmotic injury usually not required when fibula fracture within ______ cm of plafond

A

4.5

185
Q

Weber A fracture has <______% associated syndesmotic injruy

A

10

186
Q

Weber B fracture has ______% associated syndesmotic injury

A

40-50%

187
Q

Weber C fracture has ______% associated syndesmotic injury

A

> 80%

188
Q

static views of ankle with associated syndesmotic injury shows what?

A

tibiofibular clear space
tibiofibular overlap
medial clear space

189
Q

dynamic views of syndesmotic injury

A

gravity stress
manual external-rotation stress
cotton/hook test

190
Q

how do you get a manual external-rotation stress view?

A

abduction/external rotation stress of dorsiflexed foot

191
Q

instability of the syndesmosis is greatest in the _______ direction

A

anterior-posterior

192
Q

how to get a gravity stress test

A

patient placed in lateral decubitus position
similar effectiveness to manual ER stress test

193
Q

how to get a cotton/hook test?

A

intraoperative assessment
bone hook around fibula used to pull while placing counter traction on tibia

194
Q

intraoperative assessment
bone hook around fibula used to pull while placing counter traction on tibia

A

cotton/hook test

195
Q

treatment of syndesmotic injruy

A

syndesmotic screw or suture fixation

196
Q

indications for syndesmotic screw fixation of associated syndesmotic injruy

A

widening of medial clear space
tibiofibular clear space (AP) greater than 5 mm
tibiofibular overlap (mortise) narrowed

197
Q

syndesmotic fixation: length and rotation of _____ must be accurately restored

A

fibula

198
Q

“Dime sign”/Shentons line to determine ______

A

length of fibula

199
Q

syndesmotic fixation outcomes are strongly correlated with ______

A

anatomic reduction

200
Q

syndesmotic fixation: placing reduction clamp on _______ (1-2 cm proximal to mortise) will achieve reliable anatomic reduction

A

middle medial tibial ridge and the lateral fibular ridge at the level of the syndesmosis

201
Q

syndesmotic fixation: one or two cortical screw(s) or suture-button devices 2-4 cm above joint angled posterior to anterior _______ degrees (fibula posterior to tibia)

A

20-30

202
Q

suture button or screws have lower rate of malreduction and reoperation rate in syndesmotic fixation?

A

suture button

203
Q

syndesmotic screws should be maintained in place for at least ____ weeks

A

8-12

204
Q

syndesmotic injury post op: must remain _____, as screws are not biomechanically strong enough to withstand forces of ambulation

A

non weightbearing

205
Q

any postoperative malalignement or widening after syndesmotic fixation should be treated with

A

open debridement, reduction, and fixation

206
Q

diabetic ankle fracture pathophysiology

A

poor circulation impairs wound and fracture healing
loss of protective sensation
poor bone quality

207
Q

non op management of ankle fractures in diabetic patients can lead to what complications

A

loss of reduction (greatest risk)
Charcot arthropathy
malunion
nonunion

208
Q

non op indications for diabetic ankle fractures

A

stable isolated unimalleolar fracture

209
Q

risks of operative treatment of diabetic ankle fractures

A

prolonged healing
high risk of hardware failure
high risk of infection
lower functional outcomes
need for future amputation

210
Q

how to enhance fixation in diabeticc ankle fractures

A

multiple quadricortical syndesmotic screws (even in the absence of syndesmotic injury)
tibiotalar Steinmann pins or hindfoot nailing
ankle spanning external fixation
augment with intramedullary fibula K-wires
stiffer, more rigid fibular plates

211
Q

maintain non-weightbearing postop ankle fractures in diabetics for ____ weeks

A

8-12 weeks

212
Q

how long to maintain non weight bearing in diabetics versus normal patients

A

8-12 weeks in diabetics vs 4-8 weeks in normal patients

213
Q

complications of non op ankle fracture management

A

ulceration from cast
delayed union or nonunion
malunion
post-traumatic arthritis
DVT (5%)
ankle stiffness

214
Q

complications of operative management of ankle fractures

A

wound problems (~5%)
deep infections (1-2%)
post op stiffness
posttraumatic arthritis
neurologic injury
hardware irritation
complex regional pain syndrome

215
Q

deep infections occur in diabetic patients up to ____%

A

20

216
Q

largest risk factor for deep infections in diabetic patients is presence of ______

A

peripheral neuropathy

217
Q

_______ of tibial plafond in SAD injuries should be addressed at time of surgery

A

articular impaction

218
Q

post-operative stiffness-can have
loss of dorsiflexion with _____ fixation

A

posterior

219
Q

post traumatic arthritis very common in _____ type injuries

A

log splitter in which trans-syndesmotic fracture-dislocations in which the talus is driven into the distal tibiofibular articulation)

220
Q

log splitter injuries aka trans-syndesmotic fracture-dislocations in which the talus is driven into the distal tibiofibular articulation) are associated with what complication

A

posttraumatic arthritis

221
Q

At risk with lateral approach to distal fibula, posterolateral, and anterior/anterolateral approaches

A

superficial peroneal nerve

222
Q

risk factors for hardware irritation

A

younger age
women
longer operative time

223
Q

posterolateral plating of fibula
risk factors
distal placement of fibula plate
protruding screw head in most distal hole of fibula plate

A

peroneal tendonitis

224
Q

risk factors for peroneal tendonitis

A

distal placement of fibula plate
protruding screw head in most distal hole of fibula plate

225
Q

at risk with posterior medial malleolus screw placement

A

posterior tibial tendonitis

226
Q

risk for posterior tibial tendonitis

A

posterior medial mall screw placement

227
Q

risk factors for adverse outcomes

A

older age
osteoporosis
diabetes
peripheral vascular disease
female
higher ASA
smoking
alcohol use
lower level of education

228
Q

positive predictors for good outcomes

A

age <40
male
ASA 1 or 2
absence of diabetes

Orthobullets Trauma (63 decks)

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