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Ortho > ankle fractures > Flashcards

ankle fractures Flashcards

1
Q

The flat part of the distal tibia that articulates with the talus is called what

A

tibial plafont

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2
Q

This is a rectangular socket created by the medial malleolus, tibial plafont, and lateral malleolus

A

ankle mortise

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3
Q

Pneumonic for remembering the 4 syndesmotic ligaments?

A

“PAINT”

  • Posterior Inferior Tibiofibular (PITFL)
  • Anterior inferior Tibiofibular ligament (AITFL)
  • Interosseous ligament
  • inferior transverse ligament
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4
Q

How much tibia/fibula overlap should there be on x-ray

A

> 6 mm on AP

>1 mm on mortise

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5
Q

How much Tibia/Fibular clear space should there be on x-ray

A
  • <6 mm on AP

- <6 mm on mortise

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6
Q

what is the medial clear space on ankle x-ray and what should it measure

A
  • Space between medial malleolus and talus on mortise view

- should be < 4 mm

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7
Q

What is used to determine whether the fibula is shortened or at an appropriate length

A

Dime sign

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8
Q

Common ankle fracture classifications?

A
  • Lauge Hansen

- Webber

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9
Q

Lauge Hansen ankle fractures are based on what

A

mechanism of injury

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10
Q

Most common Lauge Hansen ankle fracture

A

-Supination External Rotation (SER)

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11
Q

What are the 4 stages of Lauge Hansen SER fx

A

1) ATFL sprain
2) Distal fibula fx: - Spiral pattern, from anteroinferior, at the level of syndesmosis
3) PITFL rupture or Posterior malleolus fracture
4) Medial malleolus transverse fx or Deltoid ligament rupture

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12
Q

Stages of Lauge Hansen supination Adduction (SAD) injury

A

1) Talofibular ligament sprain or Distal fibula avulsion fx: below the plafond, transverse pattern
2) VERTICAL MEDIAL MALLEOLUS FX and impaction of anteriormedial distal tibia

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13
Q

Stages of Lauge Hansen Pronation ABduction (PA) Fx

A

1) Medial malleolus transverse fx or deltoid ligament rupture
2) ATFL sprain
3) Distal Fibula fracture: oblique/comminuted fibula fx, at or above the level of the syndesmosis

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14
Q

Stages of Lauge Hansen Pronation external rotation (PER) fx

A

1) Medal malleolus transverse fx or Deltoid ligament rupture
2) Anterior tibiofibular ligament disruption
3) Distal fibula fx: Spiral pattern, Anterosuperior to posteroinferior, above the level of the syndesmosis
4) Posterior tibiofibular ligament rupture or posterior malleolus fx

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15
Q

Describe the Danis-Weber ankle fx classification

A
  • Based on the level of the fibular fx
  • A: below level of tibial plafond
  • B: at or near level of tibial plafond
  • C: above level of the syndesmosis
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16
Q

Describe the correlation b/t Danis Weber and and Lauge Hansen classifications

A
  • C: PER or PA
  • B: SER
  • A: SAd
17
Q

Management of ankle fracture w/ dislocation in ER

A
  • Hematoma block
  • closed reduction and spling
  • Even if they need surgery, reducing the disolocation will calm down tissues
18
Q

Describe how to put hematoma block

A
  • find tibialis anterior by having patient dorsiflex the great toe and go medial to the tendon
  • Aim towards posterior aspect of lateral malleolus
19
Q

proper splint for ankle fx

A
  • AO splint

- Consists of “U” stirrup and posterior slab

20
Q

what are the operative indications in an ankle fx? . .. basically what makes it unstable

A
  • Bimalleolar fx
  • Bimalleolar equivalent fx: medial clear space > 4 mm
  • Trimalleolar fx
  • Syndesmostic injury
  • Posterior malleolar fx: >25% articular involvement or > 2 mm articular step off
  • Displaced isolated lateral malleolar fx: >3 mm displacement
  • Displaced isolated medial malleolar fx: any displacement or Talar shift > 1 mm
21
Q

If you see an isolated lateral malleolus fx at or above the level of the syndesmosis, in order to make sure that you don’t have a medial malleolar equivalent or deltoid rupture what must you do?

A

must get an external rotation stress view

22
Q

Describe the ORIF for lateral ankle fx

A

-Lag screw and 1/3 tubular plate

23
Q

Describe the ORIF of the medial side malleolar fx

A

-partially threaded cancellous screw

24
Q

How do you intraoperatively test for syndesmotic stability

A
  • Cotton test or

- External rotation stress test

25
Q

Plan for Syndesmotic injury operatively

A

-all plans different so could look this up

26
Q

Ankle fx dislocation where fibula gets entrapped behind the posterolateral ridge of the tibia

A

Bosworth fx

27
Q

what nerve will be in danger during the lateral approach to the ankle

A

superficial peroneal nerve

Ortho (18 decks)

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