Ankle fractures and foot Flashcards
Medial ligament
Deltoid ligament
Lateral ligaments
Anterior and posterior inferior talofibular ligaments
Calcaneofibular ligament
Immediate Mx
ATLS History and examination Check NV status Gain IV access and take bloods Give pain relief Reduction + below knee back slab Recheck NV supply + xray Fixation Rehab
If open: Abx Tetanus Picture Cover wound with a sterile dressing
Mechanism of injury
Inversion or eversion
Blisters
Cleavage injury between dermis and epidermis due to friction
Severe soft tissue injury
Fracture examination
Proximal fibula Syndesmosis Midfoot Subtalar joint Base of 5th metatarsal Sensation and pulse
Ottawa rules for radiotherapy
Xray indicated if:
- tenderness over posterior half of lateral malleolus and base of 5th metatarsal
- tenderness over the posterior half of medial malleolus and navicular tuberosity
- Unable to weight bear
Mortise view
Xray taken with leg internally rotated by 15 - 20 degrees
medial clear space should be within 4mm all the way around
Syndesmosis overlap of 1mm
Unstable fracture
Talar shift
Fracture in 2 places
Weber C fracture
Talar shift
Talus displaced laterally so medial clear space increases
What causes talar shift
Deltoid ligament tear
medial malleolus fracture
Normally Weber B
Weber classification
Weber A - below syndesmosis
Weber B - at syndesmosis
Weber C - above syndesmosis
Weber mx
Weber A - normally stable with non surgical mx
Weber B - normally stable but can have talar shift
Weber C - always unstable requires surgery
Stress test
If unsure whether stable or unstable pt can test stability by weight-bearing Xray
SPAN/ SCAN/PLAN
SPAN - external fixation when extensive soft tissue injury
SCAN - CT
PLAN - plan surgery if internal fixation needed and rehab
Commonest cause of injury
Supination ecternal rotation
How to treat isolated Weber B
Treat symptomatically if stable
Unstable - with boot and review after 1 week with Xray on admission
Trimalleolar fracture Ix
Requires CT for surgery planning
Hindfoot nailing
Consider to allow pt to mobilise quicker
If there is very poor soft tissue quality
Ankle fracture in diabetics
Investigate:
- charcot foot
- vascular compromise
- infection - osteomyelitis
Longer healing time
Double fixation required
Hallux Valgus
• Great toe deviates laterally at MTP joint • Pressure of MTP against shoe → bunion • ↑ wt. bearing at 2nd metatarsal head - pain: “Transfer metatarsalgia” - → hammer toe
Morton’s neuroma
• Pain from pressure on an interdigital neuroma
between the metatarsals.
• Pain radiates to medial side of one toe and lateral side
of another.
• Rx: neuroma excision
Ix of ankle fractures
Xray - AP and lateral
CT scan if complex
Complications of ankle fracture
OA
ORIF - DVT, NS injury, nin - union and metal work prominence
Ankle sprain
Present following inversion:
High ankle sprains - injuries to the syndesmosis
Low ankle sprains - injuries to the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL)
Mx: RICE
Calcaneal fracture mechanism of injury
Fall from height whereby there is significant axial loading directly onto the bone.
Often presents with concurrent fractures
Achilles Tendonitis
Inflammation of the Achilles (calcaneal) tendon prevalent in those that do high-intensity activities such as running and jumping
Clinical features of Achilles Tendonitis rupture
Sudden-onset severe pain in the posterior calf
Audible popping sound
On examination:
Loss of power of ankle plantarflexion
Simmonds’ Test
Test for Achilles tendon rupture.
Patient kneeling on a chair, with the affected ankle hanging off the edge of the chair, squeeze the affected calf. If the Achilles tendon is in continuity, the foot will plantarflex; however, plantarflexion is absent when the tendon is ruptured.
Management of Tendonitis
Stop precipitating exercise NSAIDs
Ice
Rehab and physio
Achilles tendon rupture mx
Analgesia
Immobilisation with slpint in a plaster - 2 weeks then 4 weeks then neutral position for 4 weeks
Plantar fasciitis
Inflammation of the plantar fascia
Caused by micro tears
Sharp pain across the plantar aspect of the foot, most severely in the heel
Clinical diagnosis
RF for plantar fasciitis
Anatomical factors, such as excessive pronation or pes cavus (high arches)
Weak plantar flexors or tight gastrocnemius or soleus
Prolonged standing or excessive running
Leg length discrepancy
Obesity
Unsupportive footwear
Mx of plantar fasciitis
Activity moderation Regular analgesics Physio Shoe with a well-cushioned heel Corticosteroid injections
Syndesmosis
Binds the distal tibia and fibula together
Consist of:
- anterior inferior tibulofibular ligament
- posterior inferior tinulofibular ligament
- interosseus ligament
