ankle pathology Flashcards
what is the weber classification of ankle fractures
A - below the syndesmosis
B - at the level of the syndesmosis
C - above the syndesmosis
(the more proximal the ankle fracture, the more unstable it is)
what joins the tibia and fibula
the syndesmosis which is made of the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament and the intraosseous membrane
clinical features of ankle fractures
pain and deformity (the more deformed, the higher the likelihood of neuromuscular compromise)
what are the ottawa rules for ankle fractures
1) bone tenderness at medial malleolus 2) bone tenderness at lateral malleolus 3) unable to weight bear 4 steps
when are the ottawa rules used
when there is any diagnostic uncertainty
when can the ottawa rules not be used
if the patient is intoxicated or if there is gross swelling
Ix for ankle fracture
AP, lateral and mortise view
MX of ankle fracture
needs immediate reduction and stabilisation in a below knee backslab cast. May need ORIF if weber C, if bimalleolar or if weber B and talar shift
complications of ankle fractures
post traumatic arthritis
what is a normal medial clear space
4 and below
what mechanism normally causes ankle fracture
twisting mechanism
ankle OA normally occurs secondary to trauma rather than idiopathically, why is this?
ankle normally well protected from OA due to a different pressure distribution and high cartilage density
Tx for ankle OA
1) arthroscopy (where the joint is cleaned out under keyhole) 2) arthrodesis 3) ankle prosthesis
achilles tendinopathy presentation (due to microtrauma of the tendon - typically when started to do more exercise than was previously done before)
gradual onset of pain/stiffness
RF for achilles tendiinopathy
obesity, inflammatory conditions like RA and quinolones
