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YR6: T+O > Ankle injuries > Flashcards

Ankle injuries Flashcards

1
Q

What guides clinical examination of ankle injuries? Why?

A

Ottawa ankle rules
To minimise unnecessary X-rays

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2
Q

What is stated by the Ottawa ankle rules?

A

X-rays are only necessary if there is pain in the malleolar zone AND:
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia
3. Bone tenderness over the distal fibula

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3
Q

Describe the anatomical landmarks of the lateral malleolar zone

A

Tip of lateral malleolus to include lower 6cm of posterior border of fibular

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4
Q

Describe the anatomical landmarks of the medial malleolar zone

A

Tip of medial malleolus to lower 6cm of posterior border of tibia

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5
Q

List 3 classification systems for ankle fractures

A

Potts
Weber
AO

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6
Q

Describe the Weber classification of ankle injuries

A

Related to level of fibular fracture
A: Below syndesmosis
B: fractures start at level of tibial plafond + may extend proximally to involve the syndesmosis
C: Above syndesmosis which may itself be damaged

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7
Q

Name a subtype of Weber fracture

A

Maisooneuve fracture
May occur with spiral fibular fracture that leads to disruption of syndesmosis with widening of ankle joint
(Requires surgery)

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8
Q

How should all ankle fractures be managed?

A

Promptly reduced to remove pressure on the overlying skin + subsequent necrosis

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9
Q

How should young patients with unstable, high velocity or proximal ankle fracture injuries be managed?

A

Surgical repair
Often using compression plate

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10
Q

How should elderly patients, even with potentially unstable ankle fracture injuries be managed?

A

Conservative Mx as their bone does not hold metalwork well

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11
Q

Describe the configuration of the ankle joint

A

Distal tibia + fibula form a mortise
Superior aspect of the talus acts as a tenon

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12
Q

What binds the distal fibula and tibia together? What is this composed of/

A

Syndesmosis
Anterior inferior tibiofibular ligament (AITFL)
Posterior infection tibiofibular ligament (PITFL)
Interosseous ligament (IOL)
Interosseous membrane

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13
Q

What secures the distal fibular to the talus?

A

Anterior + Posterior talofibular ligaments (ATFL + PTFL)

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14
Q

What secures the distal fibular to the calcaneus?

A

Calcaneofibular ligament

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15
Q

Which ligaments are referred to collectively as the lateral collateral ligaments?

A

ATFL, PTFL + Calcaneofibular ligament

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16
Q

What secures the distal tibia to the talus?

A

Deltoid ligament

17
Q

What is a strain?

A

Stretching, partial or complete tear of a ligament

18
Q

How are ankle sprains divided?

A

High ankle sprains (involving syndesmosis)
Low ankle sprains (lateral collateral ligaments)

19
Q

Which type of ankle sprain is most common?

A

Low ankle sprains with injury to ATFL most common

20
Q

What is the most common mechanism of low ankle sprain?

A

Inversion injury

21
Q

How may patients present with low ankle sprains?

A

Pain, swelling + tenderness over affected ligaments
+/- bruising
Usually able to weight bear unless severe

22
Q

What are the grades of low ankle sprain?

A

I (mild): stretch/ micro-tear of ligament, minimal bruising + swelling, no pain on weight bearing

II (mod): partial tear of ligament, mod bruising + swelling, minimal pain on weight bearing

III (sev): complete tear of ligament, severe bruising + swelling, severe pain on weight bearing

23
Q

What investigations should be performed for suspected ankle sprain?

A

X-ray according to Ottawa ankle rules (15% a/w fracture)
MRI if persistent pain

24
Q

Describe management of low ankle sprains

A

RICE
Occasionally removable orthosis, cast +/or crutches
If Sx persist/ significant joint instability: MRI + surgical intervention (rare)

25
Q

Describe prevalence of high ankle sprains

A

Injuries to syndesmosis are rare (0.5%) + severe

26
Q

Describe the usual mechanism of injury of high ankle sprains

A

External rotation of the foots causing the talus to push the fibula laterally

27
Q

How do patients with high ankle sprains present?

A

Frequently find weight-bearing painful

28
Q

What test can be performed to detect high ankle sprains?

A

Hopkin’s squeeze test
Pain when tibia + fibula are squeezed together at leave of mid-calf

29
Q

What investigations are used in suspected high ankle sprains?

A

X-ray: may show widening of tibiofibular joint (diasasis) or ankle mortise
MRI: if high suspicion syndesmotic injury but normal XR

30
Q

Describe treatment of high ankle sprains

A

If no diastasis: non-weight-bearing orthosis or cast until pain subsides.
If diastasis or failed non-operative Mx: operative fixation

31
Q

Describe prevalence of isolated injuries to the deltoid ligament in the ankle. What are they frequently associated with?

A

RARE
a/w fracture
Look for Maisonneuve fracture of proximal fibula

YR6: T+O (10 decks)

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