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Podiatry Handbook notes > Ankle Pathology > Flashcards

Ankle Pathology Flashcards

1
Q

Which Lateral Collateral ligaments are most commonly injured

A

1) ATFL- 95%
2) CFL
3) PTFL

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2
Q

MOI CFL and ATFL

A

CFL- DF+inversion. May also tear peroneal tendon sheath

ATFL- PF+inversion

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3
Q

Deltoid ligament: deep vs. superficial

A

Deep- anterior tibiotalar

Superficial: Tibionavicular, posterior tibiotalar, tibiocalcaneal

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4
Q

MOI of ankle joint capsule tear

A

due to hyper PF such as accidentally kicking the ground.

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5
Q

What is the classification system for ankle sprains

A

Diaz classification

Grade 1: ATFL injury
Grade 2: CFL injury
Grade 3: ATFL+CFL
Grade 4: PTFL

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6
Q

Function treatments for ankle sprain and timeline (5)

A

1) RICE/NSAIDS: immediately
2) Brace in Dorsiflexion: 1-3 weeks
3) ROM exercise: 3-6 weeks
4) Return to activity: 6-12 weeks
5) Prevent recurrence

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7
Q

Ankle fracture: what signs are you looking for on X-ray (3)

A
  • Tib-fib overlap
  • medial clear space
  • how the talus sits in the ankle mortise
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8
Q

Clinical exams that can be done to diagnose ankle fractures (5)

A
  • Anterior drawer test
  • talar tilt test
  • proximal squeeze test: least reliable
  • Distal compression : better test for syndesmosis injury
  • Eversion stress test: evert foot against the fibula. Better test for syndesmosis injury.
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9
Q

Exam that can be done in the OR for syndesmosis injury

A

Cotton test/hook test- best test for syndesmosis injury

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10
Q

Radiographic view to use for ankle injury

A

-Ankle mortise view

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11
Q

Components to look for on X-ray with ankle injury (5). The measurements and which is most reliable

A

-Medial clear space: >4mm abnormal
-Tib fib clear space: greater than or equal to 6mm abnormal. MOST RELIABLE
- Inversion stress view
Talocrural angle

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12
Q

X-ray findings to confer fibular length (2).

A

Shenton’s lines: line continues with spur of lateral malleolus with tibial plafond

Dime sign: assesses fibular length and talocrural angle

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13
Q

X-ray findings to check posterior malleolus (2)

A
  • external rotation on lateral view

- Double contour sign

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14
Q

Three classification systems for ankle fractures

A
  • Weber
  • Lauge-Hansen
  • Danis-Weber
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15
Q

Weber Classification (4)

A

A- fracture of the medial malleolus below the level of the ankle joint
B- Transverse fracture of the medial malleolus
C- Oblique fracture of the medial malleolus
D- vertical fracture of the medial malleolus

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16
Q

Danis Weber classification

A

A- fibular fracture below the level of the ankle joint
B- fibular fracture at the level of the ankle joint
C- fibular fracture above the level of the ankle joint

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17
Q

Lauge Hansen: 4 major groupings

A

Supination adduction (LH A)

Supination external rotation ( LH B)

Pronation Abduction (LHB)

Pronation external rotation (LH C)

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18
Q

Supination adduction

A

I: Avulsion fracture of the fibula
II: vertical fracture of the medial malleolus

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19
Q

Pronation abduction

A

I: Avulsion fracture of the tibia
II: PITFL and AITFL
III: Fracture of the fibula

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20
Q

Supination external rotation

A

I: AITFL injury
II: Fracture of the fibula (posterior spike) (Most common)
III: PITFL injury
IV: Medial malleolus fracture

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21
Q

Pronation External rotation

A

I: Medial malleolar fracture
II: AITFL
III: Fibular fracture (above the level of the ankle joint)
IV: PITFL

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22
Q

What is the problem with the lauge hansen classification system

A
  • Cadaveric study with the tibia stationary
  • Does not dictate treatment
  • 10% of fractures cannot be classified using this system
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23
Q

Tillaux-Chaput definition

A

avulsion fracture of the tibia from the AITFL

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24
Q

Wagstaffe definition

A

avulsion fracture of the fibula from the AITFL

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25
Q

Volkmann definition

A

avulsion fracture of the tibia from the PITFL

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26
Q

Bosworth definition

A

avulsion fracture of the fibula from the PITFL

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27
Q

Maisonneuve fracture definition

A

fracture of the proximal fibula corresponding with PER III

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28
Q

Pott’s fracture

A

bimalleolar fracture

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29
Q

Cotton fracture

A

trimalleolar fracture

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30
Q

Bimalleolar equivalent

A

rupture of the deltoid ligament instead of medial malleolar fracture. More unstable than actual fracture of the medial malleolus

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31
Q

Coonradd bugg trap

A

interposition of PTT prevents reduction of medial malleolar fragment

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32
Q

Butterfly fragment

A

in PAB, triangular wedge of cortical bone part of the comminuted fracture

33
Q

Vassals phenomenon

A

reduction of the primary fracture allows the other fractures to self reduce

34
Q

Greenstick fracture

A

only one cortex affected because the other side is too soft to break. Due to bending force

35
Q

Torus fracture

A

Common pediatric fracture at the transitional zone between the metaphysis and diaphysis

36
Q

Closed reduction: name of the technique and steps

A

Charnley technique

1) exaggerate
2) distraction
3) reduction

37
Q

What to do in ankle fracture if the talus will not reduce

A

surgical emergency due to the neurovascular/skin compromise.

38
Q

Surgical goal with ankle fractures

A

1) Maintain fibular length
2) Maintain ankle mortise
3) Ensure proper alignment of the talus
4) protect the syndesmosis

39
Q

With ankle fractures what is the key to success concerning the lateral malleolus

A

quality of reduction

40
Q

With ankle fractures with is the relationship between the talus and the fibula

A

fibula acts as a buttress, and the talus follows any fibular displacement

41
Q

How to fixate oblique fracture at the lateral malleolus

A

with an interfrag screw

42
Q

How to reduce fibular fracture at the midshaft or proximal fibula

A

no need to reduce just reduce the syndesmosis and those fracture will self reduce

43
Q

For ORIF of the fibula what approaches can be used

A

Anterior approach
Lateral approach
posterior approach

44
Q

things to look out for with anterior approach

A

avoid superficial peroneal N or AITFL

45
Q

How to fixate with lateral approach

A
  • interfrag screws in lag technique perpendicular to fracture line
  • 1/3 tubular plate used to neutralize torsional rotational force
  • At least 2 bicortical screws proximally and 2 unicortical screws distally
46
Q

Posterior approach caution and how to fixate

A

caution with the sural nerve

-use an anti-glide plate for best stability. Use unicortical screws distally to avoid entering the lateral gutter

47
Q

With ankle fractures when is the only time to use only lag screw fixation on the fibula

A

long oblique and non-comminuted fractures only

48
Q

How to fixate a Maisonneuve fracture

A

syndesmotic screw at distal fibula will reduce proximal fibular fracture

49
Q

How to fixate the medial malleolus (4)

A
  • tension band
  • 2x 4.0mm cancellous partially threaded screws across the medial malleolus
  • K-wire
  • antiglide plate
50
Q

When to fixate the posterior malleolus

A

when more than 25% of the articular surface is effected

51
Q

Techniques used to fixate the posterior malleolus

A

From posterior: better screw purchase. However requires more dissection

From anterior: Technically easier however difficult to get all threads in without screw being too long or short

52
Q

Syndesmosis injury what is the goal of treatment

A

reduction of fibular in fibular incisura of tibia

53
Q

What technique is used in syndesmotic fixation

A

underdrill only

insert screws parallel to joint as close to tibial plafond as possible. Direct the screws from Posterolateral fib to anteromedial tib.

54
Q

What is the gold standard for syndesmotic injury

A

Syndesmotic screw

55
Q

Syndesmotic screw:

  • Material
  • Size
  • number of cortices
  • When to remove
  • Side effects
A
  • Material: no difference between stainless steel and titanium
  • Size: No difference between 3.5 and 4.5. 4.5 easier to remove but also causes greater irritation
  • number of cortices: 1 screw across 4 cortices will have higher chance of fracture. 2 screws across 3 cortices have better stability, better physiological movement
  • When to remove: at 3-4 months
  • Side effects: limitation of ankle ROM, broken screw, pain , screw removal, syndesmosis diastasis.
56
Q

When is it not necessary to fixate syndesmosis?

A

When either the mosterior malleolus or medial malleolar osteoligamentous complex are fixated

57
Q

Etiology of a pilon fracture

A

axial load of the talus being driven into the tibia

58
Q

Foot position and location of tibial fragment(3)

A

Dorsiflexed foot= anterior tibial fragment

Neutral foot = both anterior and posterior tibial fragment

Plantarflexed foot= posterior tibial fragment

59
Q

What other injuries should you look for in someone with a pilon fracture

A

calcaneus, tibial plateau, pelvis , acetabulum, and spinal damage

60
Q

What are the classification systems for pilon fractures

A

Ruedi and Allgower. AO classification

61
Q

How to treat a pilon fracture (4)

A
  • fibular reduction
  • tibial plafond reduction
  • fill any voids with cancellous bone
  • stabilize medial tibia with a buttress plate
62
Q

FDA approved methods for TAR (5)

A
  • Agility
  • STAR
  • INBONE
  • Salto-Talaris
  • Zimmer TM ankle
63
Q

What is the gold standard treatment for ankle arthritis

A

ankle fusion

64
Q

Ste ps to the Blair procedure and what is is used for

A

Remove talar body, put foot in 10-14 degrees equinus and tibial graft placed into talar neck.

-Used for talar body AVN and severely comminuted talar body fracture.

65
Q

Etiology of OCD

A

Compaction, shearing, avulsion

66
Q

Extent of damage of OCD based on

A
  • Cartilage: shallow depth

- Cartilage+ Subchondral bone: deep depth

67
Q

Classification system for OCD

A 
Berndt and Harty
1-Compression injury 
2- Partial detachment of cartilage
3- complete detachment of cartilage 
4- displacement of fragment
68
Q

DIAL

  • shape
  • stability
  • pain
  • outcome
A

Shape: shallow wafer shape
Stability: less stable more likely to be displaced
Pain: more pain
outcome: easier to treat

69
Q

PIMP

  • Shape
  • Stability
  • Pain
  • outcome
A
  • shape: deep cup shape
  • more stabile
  • less pain
  • more difficult to treat
70
Q

Ports used in arthroscopic correction of OCD (3)

A
  • anteromedial: medial to TAT, anterior to medial malleolus
  • Anterolateral- lateral to peroneus tertius, medial to lateral malleolus
  • Anterocentral- between EHL and EDL tendon
71
Q

How to treat small OCD lesions

A

through excision and curettage: subchondral drilling and microfracture

72
Q

How to treat larger lesions (4)

A
  • Mosaicplasty aka OATS (osteochondral Autograft Transplant system
  • Denovo Juvenile Cartilage Graft
  • Talar en-block
  • Subchondroplasty
73
Q

Surgical treatments for ankle instability (4)

A
  • Brostrom Gould: Brostrom ATFL repair through imbrication. Gould inferior extensor retinaculum sutured to perioseum.
  • Evans: PB routed through fibula

Watson-Jones: rerout PB tendon through fibula with ATFL repair

Chrisman Snook reconstruct ATFL and CFL using split PB

74
Q

Peroneal subluxation/displacement: MOI

A

skiing

75
Q

classification system for peroneal subluxation

A

Eckert and Davis Classification

1) Retinaculum separates from fibrocartilagenous ridge (most common)
2) Fibrocartilagenous detaches from fibula
3) Avulsion fracture of fibula (least common)

76
Q

Surgical options for peroneal subluxation (3)

A
  • Peroneal stop procedure (PB to PL tenodesis)
  • Tendon debridement
  • Peroneal tubularization
77
Q

Etiology of os peroneum syndrome (3)

A
  • os peroneum located within PL tendon
  • Fracture or diastasis of os peroneum
  • Tear or rupture of the peroneus longus tendon
78
Q

Surgical treatment for os peroneum syndrome(3)

A

excision of os peroneum

  • tendon repair
  • PB to PL tenodesis

Podiatry Handbook notes (10 decks)

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