foot and ankle Flashcards
week 5
when to use ottawa ankle rules
- applied to all pts aged >2 years who have ankle or midfoot apin and or tenderness in the setting of trauma
- ankle x ray series is only required if the pt has pain in the malleolar zone AND any of the findings
bone tenderness at the posterior edge ortip ofteh lateral malleolus, OR
bone tenderness at the posterior edge or tip of the medial malleolus, OR
inability to bear weight both immediately after injury and in the ED
management for ankle sprain could look like
- x ray
- RICE
- splinting/crutches and pain medication, pending outcome
routine radiologic evaluation of the ankle:
anterior posterior (AP) view
what can be seen
- dital tibia and fibula
- medial and alteral malleoli
- dome of talus
- ankle mortis
AP view:
radiologic observations
- latral malleolus is superimposed behind the lateral aspect of the tibia
- medial or lateral shift or displacement of the talus within the mortise may indicatethe presence of laxiyt, instability, or fracture at the ankle
- the pt position is non-weightbearing as is typical for most LE radiographs but special requests can be made for standing
what pathologies are appropriate for a weightbearing image
- syndesmosis injury
- lizfranc injury
to see the entire ankle mortises what positioning in an AP view would be best?
internally rotating the leg and foot 15-20° to place both malleoli in teh same plane, avoidingsuperimposition of the lateral aspect of the tibia over the fibula
what can you see in the lateral view
- calcaneus
- talus
- subtalar joint
- talonavicular artiulation
- calcaneocuboid articulation
lateral view: radiologic observation
- evaluate the angular relationship of the talus and the calcaneus in the presence of trauma
- and lessever values will be seen in the presence of impacted calcaneal fractures
- higher values, usually >50°, indicate a pes cavus deformity
What are the 5 components to syndesmosis sprain
- anterior inferior ibiofibular ligament (AITFL)
- posterior inferior tibiofibular ligament (PIFTL)
- interaosseus ligament
- interaosseous memebrane
- inferior transverse ligament
What is the MOI for syndesmosis sprain
- external rotation injuries
- ER forces the talus to rotate laterally and push the fibula away from tibia
- may lead to increased compressive stresses seen by the tibia
syndesmosis sprain findings on radiograph to look for
- decreased tibiofibualr overlap
- noraml >6mm on AP view
- normal >1 mm on mortise view
- increased medial clear space
- normal less than or equal to 4mm
- increased tibiofibular clear space
- normal < 6mm on both AP and mortise view
lateral foot projection
- metatarsals superimposed
- tarsals superimposed
- distal tibia and fibula
- tibiotalar joint
- boehler angle (calcaneus)
what can you see with a lateral calcaneus projection
- calcaneus
- calcaneal tuberosity
- sustentaculum tali
- sinus tarsi
- ankle (tibiotalar) joint and adjacent tarsals
what is bohlers angle? what view is it been seen in? what is normal degrees?
calcaneal fracture
typically measured on lateral foot
normal is 20-40 any less or more would indicate a fracture
primary indications for CT of the ankle or the foot include, but are not limited to, evaluation of the following:
- severe trauma
- complex fractures and dislocations of the ankle and hindfoot
- loose bodies in the joint
- osteochondral lesions
- tarsal coalition
- preoperative planning
