Ankle: Pathologies 4 Flashcards
The Lauge-Hansen classification is based on this type of injury
Rotational MOI
Lauge-Hansen Classification: categories
- supination external rotation (SER)
- supination adduction (SA)
- pronation external rotation (PER)
- pronation abduction (PA)
Lauge-Hansen Classification: supination external rotation injury (SER)
types of injuries seen
- Injury of anterior inferior tibiofibular ligament
- Oblique/spiral fx of distal fibula
- Injury of posterior inferior tibiofibular ligament or avulsion of posterior malleolus
- Medial malleolus fx or injury to deltoid ligament
Lauge-Hansen Classification: supination adduction (SA)
Types of injuries seen
- Transverse fracture of distal fibula
2. Vertical fx of medial malleolus
Lauge-Hansen Classification: Pronation external rotation (PER)
Types of injuries seen
- Medial malleolus fx or injury to deltoid ligament
- Injury of anterior inferior tibiofibular ligament
- Oblique/spiral fx of fibula
- Injury of posterior inferior tibiofibular ligament or avulsion of the posterior malleolus
Lauge-Hansen Classification: Pronation external rotation (PER)
Where might an oblique/spiral fx of the fibula occur?
Proximal to the tibial plafond
Lauge-Hansen Classification: Pronation abduction (PA)
Types of injuries
- Medial malleolar fx or injury to deltoid ligament
- Injury of anterior inferior tibiofibular ligament
- Transverse or comminuted fx of fibula proximal to tibial plafond
Danis-Weber fractures
Type A: location
Below level of tibial plafond (syndesmosis)
Danis-Weber fractures
Type A: occur below the level of the tibial plafond (syndesmosis) and may be associated with what type of fractures?
Oblique or vertical medial malleolar fractures
Danis-Weber classification
Type B: location
- At the level of the tibial plafond (syndesmosis)
- Extend proximally in an oblique fashion
Danis-Weber classification
Type C: location
Proximal to level of tibial plafond
Danis-Weber classification
Type C: occur proximal to level of tibial plafond and often have these associated injuries
- syndesmotic
- medial malleolus fx
- deltoid ligament injury
Calcaneal fractures: account for (%) of fractures in the foot
10%
Calcaneal fractures: what is the primary difficulty following surgery?
Achieving anatomical alignment
Calcaneal fractures: ORIF are currently advocated for what types of fractures?
- intra-articular with displacement (>1 mm)
- extra-articular fx that involve soft tissue and/or that have significant malalignment
Calcaneal fractures: What constitutes significant malalignment?
> 10˚ valgus
> 5˚ varus
Calcaneal fractures: Rehab
When to begin ROM and manual therapy
As soon as pt is weight bearing
Calcaneal fractures: Rehab
Manual therapy for…
Talocrural
Subtalar
Midfoot
Toes
Metatarsal fractures: account for (%) of ankle/foot fractures
< 2%
Metatarsal fractures: Often associated with what injury
Ankle sprains at the 5th MTP
Metatarsal fractures: Why associated with ankle sprains at the 5th MTP?
Due to strong contraction of peroneus brevis during twisting injury
Metatarsal fractures: how long does it need to be immobilized?
6-8 weeks
Metatarsal fractures: 6-8 weeks immobilized followed by
- progressive WB
- addressing impairments
Stress fractures: common sites in the ankle
- anterior tibia
- medial malleolus
- navicular
- proximal 5th metatarsal
- sesamoids
- metatarsal shafts
Stress fractures: how many grades
3
Stress fractures: Grade 1
Periosteal edema on fat suppressed T2 (shin splints)
Stress fractures: grade 1 aka
Shin splints
Stress fractures: Grade 2
Grade 1 + marrow edema on T2 image
Stress fractures: Grade 3
Grade 2 + clearly visible fracture
Anterior tibial stress fracture:
Intervention
Rest
Pneumatic boot
Sometimes require protected WB
Anterior tibial stress fracture:
Return to sport when?
8 mos
navicular stress fracture: (high/low) risk for complications
High
navicular stress fracture: Time to return to sport
8 mos
navicular stress fracture: How long NWB in cast
Usually NWB in cast until healed
Metatarsal stress fractures: treatment
NWB short leg cast 6-8 weeks
