Chpt 102: ankle dislocation

Question 1

for a completely detached talus, what can be done to prevent infection prior to reimplantation

Answer 1

talus in bacitracin solution 2-3 times. then gently scrubbed before reimplantation.

Question 2

how long are antibiotics usually given after wound closure

Answer 2

for another 48 hours; the KEY is to removal all unhealthy tissue

Question 3

what is the most comomon complaint for prognosis of ankle dislocation

Answer 3

stiffness

Question 4

definitive wound laceration closure should be obtained within what time frame

Answer 4

within one week

Question 5

what is important to consider when reducing ankle/ what is the sequence for ankle reduction

Answer 5

1. adequate conscious sedation
2. Hip and knee are flexed to relaxed the pull of the gastroc and held for countertraction
3. use quigley maneuver if needed

Question 6

MOI with a medial subtalar joint dislocation

Answer 6

results from plantarflexion and inversion around the sustentaculum that initially disrupts the TN joint before the talocalcaneal joint . (will look like an acquired club foot)

Question 7

MOI for lateral subtalar joint dislocation

Answer 7

forceful eversion of plantarflexed foot

Question 8

what is the key element to accurate radiographic dx for stj dislocation

Answer 8

relationship of talar head to the TN which is normally congruent on all views

Question 9

what radiographic view would be helpful in assessing the reduction of the subtalar joint

Answer 9

Broden view

Question 10

what is the main ligamentous support of the STJ

Answer 10

interossoseous ligament

Question 11

Which joint guides relocations of the STJ dislocation

Answer 11

Talonavicular: relocation manuever depends on the direction of dislocation with direct pressure on the prominent talar head

Question 12

what prevents closed reduction to be achieved with medial dislocation and lateral dislocation of stj

Answer 12

medial dislocation: buttonholing of the talar head through the extensor retinaculum
reduction blocked by peroneal tendons, EDB, talonavicular joint capsule

lateral: most common the posterior tibial tendon slung laterally over the talar neck, interposition of the flexor digitorum longus, FHL

Question 13

what is the sign of subtle lateral midtarsal fracture

Answer 13

small avulsion fracture from the navicular tuberosity, compression fracture of cuboid, or both

Question 14

JAHS Classification

Answer 14

I:hallux dorsally displaced with intact plantar plate and interosseous sesamoid ligament and all intrinsic muscle attachments

IIA: interosseous sesamoid ligament rupture causing wide separating of sesamoids

iIB: one of the sesamoids (usually the medial fractures transersely, leading to distal translation by the intact sesmophalangeal ligament

Question 15

treatment for post reduction of lesser MPJ

Answer 15

buddy taping with rigid stiff-soled shoe for about 4 weesk

Question 16

what is the most common IPJ dislocation? what is the 2nd most common IPJ dislocation?

Answer 16

mC: hallux dorsal dislocation from hyperextension force

2nd most common: PIPJ of 5th toe- occurs in dorsolateral direction from an abduction stress

Question 17

what is the MOI for a posteromedial dislocation of ankle

Answer 17

supinated (plantarflexed and inverted)

Question 18

where are the skin lacerations for posteromedial dislocation of ankle

Answer 18

skin lacerations are lateral

Question 19

how far up the ankle do you check for syndesmotic injuries

Answer 19

5 cm superior to ankle joint with lat/medial squeeze test

Question 20

what is the main ligamentous support involves the subtalar joint with dislocation

Answer 20

interosseous talocalcaneal ligament

Question 21

for STJ dislocations, what usually simultaneously gets dislocated too? what should be reduced first

Answer 21

TNJ; key is to relocate the TNJ

Question 22

what helps reinforce the TNJ relocation

Answer 22

TN ligament dorsally and the spring ligament