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Musculoskeletal 1 > Ankle Sprains and Fractures > Flashcards

Ankle Sprains and Fractures Flashcards

1
Q

Lateral Ankle ligaments

A
  • anterior tibiofilular ligament
  • anterior talofibular ligament
  • cervical ligament
  • dorsal talonavicular ligament
  • calcaneonavicular ligament
  • dorsal calcaneocuboid ligament
  • calcaneofibular ligament
  • posterior talofibular ligament
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2
Q

Medial ankle ligaments

A
  • Anterior tibiotalar ligament
  • tibionavicular ligament
  • tibiocalcaneal ligament
  • posterior tibiotalar ligament
    deltoid ligament
  • these are more formable ligaments meaning that they tend to have avulsion fracture more than sprain
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3
Q

Sprain grades

A
  • 1º= point tender, no loss of integrity (4% on stress strain curve - some micro tears)
  • 2º50% disruption, mild loss of integrity (6% - can WB with assistive device)
  • 3º= significant to complete rupture, significant loss of integrity (non WB)
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4
Q

Ankle inversion sprains: mechanism

A
  • most common
  • plantar flexion and inversion
  • anterior talofibular ligament most commonly involved
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5
Q

Intervention for ankle inversion sprains in the acute protected motion phase

A
  • early weight bearing with support (crutches and bracing)
  • manual therapy: drainage, STM, joint mobilization
  • cryotherapy
  • therapeutic exercise: passive/active ROM
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6
Q

What motion is the most important to recover with ankle inversion sprains

A
  • DF for weight bearing
  • open pack position is slightly PF
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7
Q

Intervention for the progressive loading/sensory motor/therapeutic exercise phase of an inversion ankle sprain

A
  • manual therapy, mobilization, manipulation both WB/NWB
  • balance/proprioception such as SLS
  • weight bearing functional activities and single limb balance
  • balance and sports related activities
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8
Q

Eversion ankle sprains: mechanism

A
  • less common
  • eversion with external rotation
  • can cause avulsion fracture
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9
Q

When is an eversion ankle sprain going to be stressed/what motions should be protected

A
  • stressed during pronation
  • can’t early WB to due to wanting to control stress on healing tissue
  • Arch support soles and inserts can be used to control pronation
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10
Q

High ankle sprain

A
  • mechanism DF with tibial IR
  • ER strain test
  • slower progression with rehab
  • NWB 3-4 weeks (difficult to protect against spreading in WB)
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11
Q

ER strain test

A
  • DF+ER of the foot on the tibia
  • (+) = pain
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12
Q

Tight rope procedure

A
  • high ankle sprain
  • small hole through fibula and tibia
  • feed a cable through to keep the bones from spreading
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13
Q

Achilles tendon injury

A
  • 30-50 years told (tendonosis)
  • recreational athletes
  • most occur 2-6 cm proximal to insertion
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14
Q

Why do most achilles tendon injuries occur 2-6 CM proximal to insertion

A
  • microvascular along is length decreases around this point
  • makes it susceptible to degenerative changes
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15
Q

Achilles rupture surgical procedures types

A
  • 1º repair
  • Repair with augmentation
  • reconstruction
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16
Q

1º repair

A
  • whip stitch to pull ends together
  • prevents suture from stripping down the fibers
17
Q

Repair with augmentation

A
  • the sutures (whip stitch) are strengthened with another tissue
  • fascia from gastroc, FHL, peroneus brevis, plantaris
18
Q

Reconstruction

A
  • uses fascia lata to reconstruct the tendon
19
Q

Achilles tendon repair rehab:
0-4 weeks: type of rehab and ankle immobilization

A
  • compression dressing removed few days to a week post-op
  • when compression dressing removed, below-knee cast applied; foot in 15-30ºof PF
  • at 2-3 weeks new cast applied in less PF
20
Q

Achilles tendon repair rehab:
0-4 weeks: WB restrictions

A
  • non weight bearing
  • ambulation with crutches
21
Q

Achilles tendon repair rehab: 4 weeks: type of rehab and ankle immobilization

A
  • cast set in equines removed and walking cast applied
  • ankle positioned in neutral or with controlled ankle motion brace that limits DF to 0
  • worn for 2-4 weeks
22
Q

Achilles tendon repair rehab:
4 weeks: WB restrictions

A
  • weight bearing initiated while wearing immobilizer
  • progress as tolerated
23
Q

Achilles tendon repair rehab:
6-8 weeks: type of rehab and ankle immobilization

A
  • if walking cast used: replace with CAM brace allowing DF beyond neutral
  • Active ROM exercises initiated
24
Q

Achilles tendon repair rehab:
6-8 weeks: WB restrictions

A
  • Full Weight bearing wearing functional brace
  • transition to shoe with 1-1.5 heel lift for 2-4 weeks
25
Q

Achilles tendon repair rehab:
beyond 12 weeks: type of rehab and ankle immobilization

A
  • functional brace gradually discontinued
26
Q

Achilles tendon repair rehab:
beyond weeks: WB restrictions

A
  • full weight bearing in regular shoes without lift
27
Q

What happens with a PF contracture

A
  • difficult to recover motion
  • want to protect against this from developing
28
Q

Ankle fractures: Malleolar isolated non displaced

A
  • 4-6 weeks
  • WB as healing permits
  • cast
  • 2ºbony healing
29
Q

Malleolar fracture isolated displaced

A
  • ORIF early ROM
  • 1ºbony healing
  • 1 mm displaced = 40% reduction in contact area of the talocrural join = more susceptible to degeneration
  • contact of the TCJ helps to spread the force of walking over the joint
30
Q

Bimalleolar fracture

A
  • usually unstable surgical fixation
  • equivalent lateral malleoli with deltoid ligament rupture/fracture
  • no medial or lateral stability
31
Q

trimalleolar fx

A
  • sever ER of foot and IR of tibia
  • posterior lip of tibia is fracture as well as both malleoli
32
Q

Tibial Plafond (pylon) fracture

A
  • high energy/axial compression
  • talar dome gets driven into tibia
  • intra-articular fracture = bruising to articular cartilage that can accelerate degeneration
  • significant soft tissue cartilage damage
33
Q

Talar Fracture

A
  • causes talar neck and axial load
  • talar neck fracture can cause AVN
  • similar mechanism: axial compression with dorisflexion
  • managed ORIF with below knee cast NWB
  • bone healing 6-12 weeks
34
Q

Calcaneal fracture

A
  • High velocity impact - fall off a ladder and land on heels
  • bony healing 8-12 weeks
35
Q

Calcaneal fracture ORIF goals

A
  • joint stability
  • articular congruity
  • articulate integrity
  • near anatomic alignment
36
Q

What do you expect to see with someone who is NWB

A
  • muscle atrophy of LE
  • hypomobility
  • decreased proprioception
  • plantarfasicitis - loading a foot that hasn’t been loaded

Musculoskeletal 1 (42 decks)

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