Ankle fractures + phase 1 (ankle) Flashcards
What type of the joint is the ankle joint?
Hinge joint ➞ very small amount of rotation possible between fibula and tibia
Load bearing articulation in the ankle joint occurs through where?
86% through tibial plafond
Describe the ligaments and structure of the ankle joint
Stabilised by medial and lateral malleoli and surrounded by synovial capsule
Deltoid ligament is medial ➞ prevents excess foot eversion
Lateral collateral ligament complex (3) is lateral ➞ prevents excess foot inversion
Distal Tibio-Fibular ligaments form the syndesmosis
What bone articulates with the tibia to form the ankle joint?
Talus (domed bone)
Ankle fractures are usually a result of an
A fracture of which location results?
Typically an Inversion injury most commonly fracturing the lateral malleolus.
Are ankle injuries usually open or closed?
What would be seen on examination and how does this effect treatment?
Usually closed injuries without neurovascular compromise (remember to check)
Often associated with gross swelling which can prevent timely surgery
What structures are affected in a bi-malleolar vs tri-malleolar fracture?
Give the general prinicipals of an ankle examination
List the Ottowa rules for XR in ankle injuries
Ankle XR is required only if there is any pain in malleolar zone AND any of these findings:
- bony tenderness at the lateral malleolar zone A
- bony tenderness at the medial malleolar zone B
- Inability to walk four weight bearing steps immediately after the injury and in the emergency department
Give the anatomical location of the following:
- lateral malleolar zone A
- medial malleolar zone B
lateral malleolar zone A ➞ from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular
medial malleolar zone B ➞ from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia
What classification system is used for ankle fractures?
What is its clinical relevance?
Weber Classification (essentially whether the fracture is below, at the level of, or above the syndesmosis)
Indicates likelihood of syndesmotic ligamentous disruption and hence need for surgical intervention
What type of fracture is shown below?
Weber type A
What type of fracture is shown below?
Weber type B (minor talar shift)
What type of fracture is shown below?
Weber type C
What type of fracture is shown below?
Ankle bimalleolar fracture
What type of fracture is shown below?
Ankle fracture trimalleolar
What is shown below?
Ankle fracture dislocation
What is shown below?
Fracture fixation
☆ What veins form the form the superficial venous drainage route of the lower limb
☆ What is meant by a ‘venous cutdown’?
For emergency IV access to the great/long saphenous vein
What nerves supply the anterior, lateral and posterior compartment of the leg
Anterior compartment ➞ deep peroneal nerve
Lateral compartment ➞ superficial peroneal nerve
Posterior compartment ➞ tibial nerve
☆ A fracture of the fibula can result in what nerve damage?
How would the patient present and why?
☆ Describe the arterial supply of the lower limb
☆ Describe the arterial supply of the legs and foot
☆ What two pulses can be felt in the foot? Incl their anatomical location
Dorsalis pedis ➞ between extensor hallucis longus and extensor digitorum
Posterior tibial pulse ➞ behind and slightly below medial malleolus
☆ Give the contents of the tarsal tunnel
☆ At what joint does inversion and eversion of the foot take place?
at subtalar joints
Over-inversion of the foot is likley to rupture which specific ligament?
How do we assess this?
Anterior talofibular!
Ankle drawer test can be used to examine for an ATFL tear
Lable the 5 nerves which provide sensory innervation to the foot
☆ What are the 3 arches of the foot and what structures make up each?
