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S3 MMI > Foot and Ankle Acute Injuries > Flashcards

Foot and Ankle Acute Injuries Flashcards

1
Q

what is the most common reason for self-medication and entry into health care system

A

pain

  • multi-factorial experience influenced by culture, previous pain experience, belief, mood and ability to cope
  • may be an indicator of tissue damage but may also be experienced in the absence of an identifiable cause
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2
Q

acute vs chronic pain descriptor

A

acute
-pain present for less than 1 month
chronic
-pain present for 1 month or longer

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3
Q

red vs. yellow flags

A

red
-features of a serious underlying condition requireing immediate evaluation
yellow
-psychosocial and occupational factors that can increase the risk of chronicity in patients with acute pain

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4
Q

fear avoidance

A

behavior that is significantly associated with the experience of pain
-especially true when the pain becomes chronic
with FA behavior
-just the anticipated risk of intense pain can lead to constant awareness and monitoring of pain sensations
-can cause low-intensity sensations of pain to become unbearable for the person
-just the anticipation of increased pain or possible re-injury can further stimulate avoidance behaviors
can lead to a vicious cycle in which the fear of increased pain or re-injury leads to the avoidance of many activities, leading to inactivity and ultimately, to greater disability

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5
Q

FABQ

  • what is it
  • usefulness
A

fear avoidance beliefs questionnaire
has been shown to be a useful screening tool to identify acute LBP patients who will return to work by 4 weeks after injury

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6
Q

ankle sprains incidence in football players

-most common injuries

A

lateral ankle sprain
syndesmotic sprain
metatarsophalangeal dislocation/turf toe

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7
Q

effect of a brace on ankle injury

A

may be preventative

does not appear to affect the magnitude of the sprain

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8
Q

what rules do you use if you suspect an ankle fracture

A

Ottawa Ankle Rules

Bernese Ankle Rules

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9
Q

what would be an extenuating factor to indicate referral of a child/adolescent

A

recent growth spurt

-within 1 year if you’re Tom

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10
Q

low ankle sprain

  • what % of low ankle sprains
  • most common MOIs
A

80-85%
MOI
-plantarflexion with hindfoot inversion
-plantarflexion with hindfoot inversion and adduction of forefoot

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11
Q

why do you have distal effusion with an ATFL tear?

A

you tear the capsule as well and fluid moves into the interstitial space

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12
Q

inversion sprains: plantarflexion with hindfoot inversion

-what is injured

A

always damage ATFL
is severe, CFL
-peroneals will contract and help protect CFL
may also damage bifurcated ligament

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13
Q

why do you need a lace up brace with an ATFL injury

A

control anterior glide of the talus

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14
Q

why is a CFL tear so bad

A

you lose control of the talocrural joint as well as the subtalar joint

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15
Q

red flags - lateral sprains

A

fracture of 5th met

  • zone I
  • zone II
  • zone III
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16
Q

5th met fractures: classifications

  • zone I
  • zone II
  • zone III
A 
I
-avulsion Fx
II
-Jones Fx
--near articulation of cuboid and 5th
III
-5th met base Fx
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17
Q

grade I ankle sprain: functional classification

A

mild tenderness and swelling
slight or no loss of function
no mechanical instability (negative clinical stress exam)

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18
Q

grade II ankle sprain: functional classification

A

moderate pain, swelling, and mild to moderate ecchymosis
tenderness over involved structures
some loss of motion and function
mild to moderate mechanical instability

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19
Q

grade III ankle sprain: functional classification

A

severe swelling and ecchymosis
loss of function and motion
-patient is unable to bear weight or ambulate
severe mechanical instability
-moderate to severe positive stress tests

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20
Q

ankle sprain classification based on stability

A 
1
-stable
2
-unstable
-negative talar tilt test
-complete tear of ATFL
-incomplete tear of CFL
3
-unstable
-positive talar tilt test
-complete tear of ATFL and CFL
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21
Q

classification of ankle instability: mechanical

A

more than 10 mm of anterior translation on one side

-more than 3 mm of side-to-side difference

22
Q

classification of ankle instability: function

A

subjective feeling of ankle “giving way” during physical activity or everyday activities

23
Q

tib-fib syndesmotic sprain

-MOI

A

forced external rotation of foot on tibia with increased dorsiflexion

24
Q

type 1 high ankle sprain

A

foot in fixed toe-out position during open cur with direct blow to lateral aspect of knee while body turning away from foot

25
Q

type 2 high ankle sprain

A

player pone on ground with foot fixed in externally rotated position with force on knee or heel in lateral direction

26
Q

high ankle sprain

-involved structures

A

anterior and posterior tibfib ligaments, with involvement of interosseous membrane in severe injuries
if increased pronation force at subtalar joint, damage to deltoid ligament and other medial ankle soft tissue structures

27
Q

high ankle sprain classification

A

grade 1
-stable joint with mild tenderness at distal TF joint - normal radiographic findings
grade 2
-partial disruption with mormal radiographic findings and positive external rotation (Klieger) and squeeze test on physical exam
grade III
-complete rupture of distal tibfib ligaments with or without deltoid ligament involvement

28
Q

tibfib syndesmotic sprains S/S

  • classic feature
  • with sever injuries
  • can also have
  • do not see
A

classic feature is tenderness to palpation over the anterior and posterior tibfib ligaments - athlete will often point specifically to this site as area of max tenderness
-tenderness can extend proximally along the IOM
with severe injuries, tenderness extends proximally over the interosseous membrane
can also have medial ankle joint soft tissue involvement (deltoid ligament) involvement based on degree of pronation force
do not see severe swelling and less ecchymotic discoloration as with typical lateral ankle sprain since damaged tissue is “extracapsular”

29
Q

tibfib sprains S/S continued

  • pain increased with
  • complaints of…
A

pain increased with stress (increased dorsiflexion)

complaints of vague instability or awkwardness of the ankle

30
Q

tibfib sprain: imaging

A

increased tibfib clear space (increased diastasis)
Frank diastasis can be seen on standard radiographs, but in partial tears must use stress radiographs, CT scans, or MRI to assess

31
Q

eversion sprains

  • occur less frequently because…
  • often result in…
A

occur less frequently because of ankle anatomy and strength of deltoid ligament
eversion sprains often result in avulsion of the medial malleolus rather than tearing of the deltoid ligament

32
Q

red flag for all sprains

A

growth plate fracture

-if patient is 13 years or younger or growth spurt within last 12 months

33
Q

Lisfranc joint complex injuries

  • also referred to as…
  • typically associated with…
  • recently, increased incidence with…
A

midfoot sprains
typically associated with high-energy trauma
-MVA or industrial accidents
recently, increased incidence with low-energy trauma
-recreational and elite athletic activity
-2nd most common foot injury in intercollegiate FB players
-also seen in gymnastics and equestrian sports

34
Q

midfoot sprains: MOI

A

direct injury
-caused by crushing load applied directly to midfoot
-object dropped on foot; another foot stepping down on midfoot
indirect injury
-caused by axial longitudinal force applied directly to the foot when in a plantar-flexed and slightly rotated position - followed by forceful abduction or twisting

35
Q

midfoot sprains

-classification of injury

A

Lisfranc ligament

36
Q

midfoot sprains management

-stage I

A

NWB cast 6 weeks

if necessary, WB AFO for 4 weeks; PT as required

37
Q

midfoot sprains management

-stage II and III

A

usually require surgery (open or closed reduction)

most cases, ORIF

38
Q

ankle fractures

  • 1st classification system developed by…
  • -based on…
  • -limitation
A

developed by Pott

  • based on # of malleoli involved
  • did not distinguish a stable vs unstable Fx
39
Q

ankle fracture classificaiton

  • 2 systems after the Pott’s system
  • -what do each of them do?
A

Danis-Weber system categorizes Fx’s based on location of distal fibular fracture in relation to syndesmosis
Lauge-Hansen system describes:
-1) position of foot at time of injury
-2) deforming force on the ankle

40
Q

ankle fractures clinical features

  • usually caused by…
  • what dictates Fx pattern
  • if a diabetic patient presents with Fx symptoms
  • high-energy mechanism should…
A

usually cause by twisting mechanism sustained as a result of a low-energy injury
position of ankle at time of injury and subsequent direction of force usually dictates Fx pattern (Lauge-Hansen System)
if a diabetic patient presents with Fx symptoms, but history of no or little trauma - must r/o Charcot neuroarthropathy
a high-energy mechanism should raise possibility of compartment symdrome fo the leg or injury to plafond (pilon fracture)

41
Q

ankle fractures: Danis-Weber system

A

type A
-Fx below the syndesmosis
-typically stable
type B
-Fx begins at joint level and extends above in oblique fashiion
-if medial malleolar Fx and deltoid ligament rupture - then unstable
type C
-Fx above the joint line, generally with syndesmotic injury - unstable

42
Q

ankle fractures: Lauge-Hansen system

-types

A

supination - external rotation
pronation - external rotation
supination - adduction
pronation - abduction

43
Q

ankle fractures: Lauge-Hansen system-

-supination - external rotation

A

most common fracture - similar to Weber type B

44
Q

ankle fractures: Lauge-Hansen system

-pronation - external rotation

A

similar to Weber type C - fracture proximal to tibial plafond
fibular fracture can be as high as fibular neck (Maisonneuve) with syndesmotic injury

45
Q

ankle fractures: Lauge-Hansen system

-supination - adduction

A

similar to a Weber type A

-transverse Fx of lateral malleolus inferior to syndesmosis with vertical Fx of medial malleolus

46
Q

ankle fractures: Lauge-Hansen system

-pronation - abduction

A

comminuted Fx of fibula above ankle mortise with medial malleolar fracture or deltoid ligament tear

47
Q

ankle and foot fractures: issues that must be dealt with by PT after healing

A

limited foot mobility with possible fixed inverted posture of rearfoot
pain in ankle/foot during weight bearing activities
inability to load the medial aspect of the forefoot, especially the 1st metatarsal head

48
Q

issues with early TAA

A

high rates of component loosening
-due to high joint loading
–during normal gait, load placed on ankle joint 5x body weight
–superior talar articular bears 75% of load
high rate of infection

49
Q

approved prostheses for taa approved for use in US

A

STAR
AGILITY Ankle
-requires fusion of mortise
SALTO-TALARIS

50
Q

characteristics of approved prostheses for TAA

A

all 3 are non-cemented

  • rely on bony ingrowth
  • require at least 8-12 week of non-WB

S3 MMI (1 decks)

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