Ankle Injuries Flashcards
Lateral Malleolus Fracture
- The most common
- Occurs with a break to the malleolus (knobbly bit on the outside)
- No surgical intervention, will heal on its own
Bimalleolar Fracture
- 2nd most common fracture
- Breaks both the medial and lateral malleolus (both knobbles)
- The ankle joint is unstable AAR
- Needs surgery
Trimalleolar Fracture
- Breaks to the lateral, medial and posterior malleolus
- These bones provide the framework that the ligaments attach to
- Requires surgery and intensive physiotherapy
Pilon Fracture
- Break to the bottom of the tibia (similar to a tib fib fracture but lower down)
- Typically occurs from a high MOI
Common MOIs of Ankle Fractures
- RTCs
- Falls - from height or standing
- Twisting/rotating/rolling mechanisms
Signs and Symptoms of Fracture
- So of throbbing pain
- Swelling
- Bruising
- Tenderness
- Deformity
- Inability to weight bear
6Ps
Pallor - deathly pale, maybe mottled in children
Paraesthesia - due to pressure on nerves
Pulselessness - caused by swelling, rupture or occlusion to blood supply
Pain
Paralysis - loss of active/range of movement
Perishing cold - distally cold to touch indicates poor perfusion
What is Compartment Syndrome
A condition where an increase in pressure inside a muscle restricts blood flow and causes pain
What Things to Look for in Compartment Syndrome
- Evidence of the 6Ps
- Disproportionate pain relative to the injury
- Palpable tension across the skin
- Swelling of an anatomical compartment
NOTE: distal perfusion may still be seen, loss of pulse is a late sign. Some injuries may require surgery so follow local guidelines carefully when transporting
Normal ROM
- Flexion/Extension - up/down
- Inversion/Eversion
Ottowa Ankle Rules
- Base of the 5th metatarsal
- Posterior edge of lateral malleolus
- Navicular bone
- Posterior edge of the malleolus
- Inability to weight bear immediately after injury/4 steps
Risk Factors for Ankle Injuries
- Participating in high-impact sports
- Osteoporosis/other bone density conditions
- Poor mobility
- Using improper techniques/sport equipment
- Suddenly increasing activity level
- Obstacles and trip hazards at home
Managment of Open Fracture
- Consider taking photographs before further treatment
- Do not irrigate the wound, remove any gross contaminants
- Where possible apply a saline soaked dressing covered with a transparent film like the sterile field from the blast dressing
- Correct any gross misalignment and splint
- Give co-amoxiclav IV/IO
- Consider traction
What Classes as a Limb Threatening Injury
- Severe pain (even with analgesia)
- Loss of pedal pulse and/or significantly delayed CRT
- Critical Skin; pale, white, discoloured or blanching
- Risk of closed fracture becoming open
- Haemorrhage in the presence of open fractures, amputation and/or degloving injuries
These are the patients you are pre-alerting to hospital with
Vacuum Splinting
- Remove jewellery before splinting as can swell around it making it more difficult to remove late, it can also cut off blood supply
- Splinting can provide cushioning to aid in extrication an transportation of the patient
- It will also be a form of pain relief as the cushioning effect can provide pressure that triggers a dulling of pain response, it will also keep the limb still to avoid any movement in transport that will cause pain
