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Emergency Medicine > foot and ankle > Flashcards

foot and ankle Flashcards

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1
Q

True foot and ankle emergencies (5)

A 
Open fractures (OR right away)
Check for pulses first!!!
Compartment syndrome/crush injury
Ischemic foot
Infection (blisters = bad)
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2
Q

red flags of foot injury

A 
edema-compare 
ecchymosis -mondor
Point Tenderness
Obvious deformity
Gait abnormality
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3
Q

mondor

A

– sign of calcaneal fx (look at the sole of the foot)

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4
Q

approach to erythema as a rf

A

Whiteness with erythema around – no vascular supply present, huge crater underneath present
Looking for streaking/lymphangitis – infection going up lymph chain (signals a much worse infxn)
Draw a line around the cellulitis – if the redness crosses the blue line, then come back right away for IV abx

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5
Q

High tib-fib squeeze

checks for

A

Syndesmotic injury – looking for maisoneuve fx

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6
Q

Ankle external rotation test allows for evaluation of

A

Syndesmotic injury

Move their foot to the side

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7
Q

Anterior drawers, talar tilt

helps evaluate what

A

ATFL or CFL injury

Stabilize lower leg with hand on top; grab the calcaneus and move the foot forward and back

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8
Q

stress foot abduction tests looks for

A

Lisfranc fracture dislocation

Move the toes and the forefoot to see if there is movement of the mid foot

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9
Q

other than MSK what other systems would you want to evaluate

A

NEURO-gross and distal
VASC DERM -DP and PT pulses; if you cant feel them- Doppler them!

DERM- Open wounds or other red flags

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10
Q

ankle rules xray

A

need to be non tender over the malleolus

weight bearing for at least three steps

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11
Q

foot rules xray

A

any tenderness in the mid foot

base of metatarsal or navicular bone

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12
Q

three views of the foot

A

AP, Lateral, and oblique views

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13
Q

three views of the ankle

A

AP, Lateral, and Mortise views

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14
Q

if problem with proximal leg get this xray

A

Calcaneal axial, high tibia/fibula (if problem with proximal leg)

suspect Calcaneal fracture

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15
Q

weber classification

A

describes destruction of syndysmosis in ankle fractures

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16
Q

weber A

A

most distal

below syndesmosis

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17
Q

weber B

A

level of syndesmosis

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18
Q

weber V

A

above level of syndesmosis

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19
Q

special view of joint that helps evaluate syndesmosis

A

stress view

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20
Q

preferred treatment for non-displaced stable fracture of the ankle (isolated malleolar)

A

Non-displaced, stable
Posterior splint, Jones, NWB
F/u 5 – 7 days

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21
Q

three types of ankle fractures

A

isolated
bimalleolar
trimalleolar

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22
Q

jones compression dressing

A

splint for ankle fracture

the idea is that you want to reduce the swelling

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23
Q

jones fractures concerns

A

not a lot of blood flow so they need to be splinted and NWB VS Dancers with is an avulsion

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24
Q

trimal MOA

A

severe force from underneath or twisting

bony ligamentous ring is completely disrupted and a cradle needs to be formed to keep the NVS intact

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25
Q

post traumatic ankle pain causes

A

Watch for Chronic Post-Traumatic Ankle Pain
Osteochondral fracture of talus
CRPS (Complex regional pain syndrome)
Occult fracture

26
Q

MOI for calcaneal fracture

what is the imaging study of choice

A

fall from a height

Imaging- NWB plain films B/L feet;

*Then if fx- CT with 3D recon is preferable

27
Q

if pt has a calcaneal fx what else do you worry about?

what do you ask any traumatic pt

A

Also worry about lumbar spine and the other foot

NECK PAIN
BACK PAIN
CP
ABD PAIN?

28
Q

management of calcaneal fx

A

NWB
Jones compression splint
If fracture blisters occur, use oil emulsion dressing to cover
Usually delay in ORIF of 1-2 weeks while edema and skin issues resolve

29
Q

talar fx MOI

A

High energy

MVA or fall

30
Q

talus tx

A

NWB
DO NOT attempt to reduce
Call for consultant
Treated as emergency due to high rate of AVN
ORIF vs casting and immobilization
Can be prolonged course for healing >12 weeks

31
Q

MOI of lisfranc

A

FORCED Dorsifelxion

MVA
fall from height
equestrian injury

CAN OCCUR WITHOUT FX but the pt will be unable to bear weigh t

32
Q

xray for suspected lisafranc

A

NWB AP and Medial Oblique radiographs;

WB and stress abduction films if old

33
Q

pts with suspected lisfranc need to monitor for what?

A

Monitor for signs of vascular injury and compartment syndrome

Check for malalignment at met-cuneiform articulation

34
Q

after establishing lisfranc what should you do?

A

Call consultant- do not attempt to reduce; it is reduced in the OR

Neuro checks in ED

If stable, Jones splint

35
Q

Fractures with high potential for bad outcomes**

A

Open fractures

Calcaneal fractures

Talar neck fractures

Lisfranc fractures

Non-reducible fractures

N O lisa tala him to cal

36
Q

fracture complications

A

Non/Mal union (jones fx)

Compartment syndrome

Complex regional pain syndrome

37
Q

what do you see with CRPS

A

Hyperalgesia

mechanical thermal allodynia

Sudomotor changes

Often occurs secondary to ankle injury!

(manage with PT)

38
Q

OCD in talus (Osteochondral defect of the talus)

A

can occur during surgery or during the injury

Usually result of impact or mal-reduction during fracture or ORIF

Needs a podiatrist

Won’t be able to walk

Easy to miss

39
Q

thermal allodynia

A

can lead to the triggering of a pain response from stimuli which do not normally provoke pain.

40
Q

who do we see ATR in

A

Common injury in men >45 yrs old

“Weekend warriors”

41
Q

presentation

A

Feel a ”pop” or like someone hit them with a bat in the back of the leg

Focal pain and inability to bear weight on affected limb

Thompson-Dougherty Test-Positive (if foot doesn’t move when calf is squeezed)= rupture
Negative= intact

42
Q

imaging if thompson’s test is weird

A

ULS
MRI

Helpful if Thompson test is questionable
Also useful if neglected rupture

43
Q

treamtent of achilles tendon tx

A

We splint the patient in equinus (pointed toe – allows your achilles to find itself)

plantar fracture

44
Q

untidy vs infected

A

Untidy
Wounds with tissue loss

Infected wounds
> 8 hours old

45
Q

mnmgt of foot fractures

A

Obtain at least two radiographic views 90° apart
Check for associated fracture/dislocation
Attempt closed reduction

46
Q

picture of less complex fractures

A

still hurt a fuck ton

Distal to metatarsal neck
Closed

Non to slightly displaced
Single

Usually treatable with taping and post op shoe

buddy tape! +post op shoe

47
Q

complex fractures of the foot

A

proximal to met neck

Involves tendon or

ligament avulsion – they have to restabilize the

tendinous or ligamentous connection

48
Q

tx of complex foot fractures

A

Multiple
Needs additional imaging
Can lead to poor outcome, even if treatment is ideal
May require ORIF and prolonged follow up

49
Q

how determine if a fx is open or not

A

look for continued oozing to determine is this open or nah

“no oozing since they arrived –> probably not open”

fat molecules in the blood–> might be open

“there is a small 1cm wound just medial to the fx, not oozing, appears superficial with some concern for open fracture”

50
Q

open fx treatment

A

Treat all open fractures as an emergency

Evaluate the patient for other injuries

Start appropriate antibiotic therapy (ANCEF)

Tetanus prophylaxis
Do an adequate (in OR) debridement and irrigation

Dry blood on a wound carries infxn

Stabilize the fracture (with towels, blankets, or splint until the consultant arrives)

Arrange appropriate wound coverage

Start early rehabilitation

51
Q

easy explanation for compartment syndrome

A

Bleeding into a compartment may lead to elevated intracompartmental pressures

blood supply going into a muscle that is considered excess might disrupt the “ziplock bag”

at risk for muscle death

IV hydration is needed to avoid rhabdomyolosis

52
Q

other than necrosis what are the complications of compartment syndrome

A

Permanent nerve and muscle loss

Rhabdomyolysis – CK is elevated

  Get renal failure and 
  can be fatal

Necrosis leading to amputation

53
Q

Charcot foot -what is it

A

Neuro-arthropathy – a relatively painless, progressive, destructive arthropathy

seen with distinct erosion of the bone

54
Q

Charcot foot -tx

A

Will mimic infection in presentation

Red hot swollen foot
Usually totally neuropathic “it doesn’t hurt”

Get plain films – will see joint destruction

Workup for infection
Basic labs- CBC, sed rate, CRP, culture wounds if appropriate

Associated plantar wounds- usually source of infection if present

55
Q

diabetic foot ulcer

A 
Polymicrobial
Poor compliance and glycemic control
Neuropathy
Hemodynamically stable?
If grey → no vascular supply
56
Q

criteria for sepsis

A

Sepsis. Meeting SIRS Criteria?

57
Q

workup for foot ulcer

A

Basic labs- CBC, CMP, sed rate, CRP

Plain films; CT helpful to eval for gas
(probe to bone is osteomyelitis )

Call for consultant and admission

To OR for I&D or more…

58
Q

treatment of foot ulcer

A

Fluids, fluids, fluids
abx

NPO (please?)

Dressings
Usually gauze to
cover until we get there

To OR for debridement

Cultures intra-op
Will require wound care for prolonged period

59
Q

what needs to be on the foot and ankle ROS

A

foot pain
swelling
coughing up blood?
CHEST PAIN

document this shit to rule out DVT

60
Q

ruling out septic joint

A

full ROM

Emergency Medicine (28 decks)

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