Foot and Ankle trauma Flashcards
what cause ankle (soft tissue) sprains?
- Trauma usually twisting forces (usually inversion/twisting forced on a planted foot)
- High energy
-Osteoporotic bone - usually lateral ligaments (A/PTFL - anterior/posterior talofibular ligaments, calcaneofibular ligaments CFL)
presentation of ankle sprian?
-takes longer to resolve than a fracture
- pain
- bruising
- tenderness
what is the management of an ankle sprain?
non-surgical: RICE (rest, ice, compression and elevation) physiotherapy surgical - Brostrum Gould - Chrisman Snook
What is the cause of ankle fracture?
common usually a result of twisting forces (usually inversion or twisting on a planted foot)
what determines need for x-ray in ankle injury?
Ottawa criteria
- severe localised tenderness (bony tenderness) of the distal tibia/fibula, or inability to weight bear for four steps
what is the classification of ankle fractures?
Weber classification
A - fracture of lateral malleolus distal to the syndesmosis/tibial plafond (connection between the distal ends of the tibia and fibula) - usually stable
B - fracture at level of syndesmosis, can be stable or unstable (e.g. distal fibula fracture WITHOUT medial malleolus fracture/deltoid ligament rupture would be stable
BUT WITH these impairments it would be unstable)
C - fracture proximal to level of syndesmosis, usually unstable* If unstable, need ORIF with plates and screws
what does talar shift/ tilt on AP x-ray mean?
Deltoid ligament ruptured
what is the prognosis of talar shift?
Ankle-joint contact pressure greatly increases»_space; subsequent risk of post-traumatic OA with even 1mm of talar shift -
SO anatomic reduction and rigid internal fixation is required to minimise this risk with any talar shift
what is a bimalleolar ankle fracture?
both medial and lateral malleoli fractured)
-Unstable,
-Usually do ORIF
(ORIF may be delayed by 1-2 weeks if there is associated soft tissue swelling and fracture blisters,
this is to reduce the risk of wound healing problems and infection
what is a calcaneal fracture?
Cause
Prognosis
Cause: fall from height onto heal
Prognosis: dependent on extent of the involvement of the subtalar joint and the degree of comminution
what is a talar fracture?Cause?
What: forced dorsiflexion with dislocationof talus or dislocation of the fracture
Cause: RTA/ aircraft crash
-High risk of AVN reduction
what is a midfoot (lisfranc) fracture/dislocation?
Uncommon
-Often overlooked
Fracture of the base of the 2nd metatarsal
-Associated with dislocation of base of 2nd metatarsal, with/without dislocation of other metatarsals at the tarso-metatarsal joints
Ligament from the medial cuneiform to the base of the 2nd metatarsal no longer holds the metatarsal in joint
what is the investigation of a midfoot (lisfranc) fracture/dislocation?
can be missed on x-ray if in doubt CT
how does midfoot (lisfranc) fracture/ dislocation presenT?
grossly swollen bruised foot unable to weight bear (be wary if x-ray looks normal)
how is a midfoot (lisfranc) fracture/ dislocation managed?
closed/open reduction with fixation using screws
what is a 5th metatarsal fracture?
Fracture of base of 5th metatarsal
Normally due to inversion injury + avulsion fracture at insertion of the peroneus brevis tendon
how should 5th metatarsal fractures be managed?
heal - need walking cast/supportive bandage/ stout boot for 4-6 weeks even if it fails to achieve bony union may have stable fibrous non-union (usually asymptomatic)
who gets 1st metatarsal fractures?
they are uncommon because it is strong and thick important so normally fixed
what is a lesser metatarsal fracture?
common - often with multiple fractures if minimal displacement then can be conservatively treated with a cast if multiple displaced fractures - stabilised with K-wires to reduce the risk of chronic pain
what is a 2nd metatarsal fracture?
a common site for stress fracture can occur spontaneously or after period of increased exercise/activity
how is a 2nd metatarsal fracture managed?
Cast until pain subsides
what is the management for a toe fracture?
Stout boot
Intra-articular fractures of the base of the proximal phalanx at the hallux: can do reduction and fixation (if fragments are sizeable)
Open fractures: debridement, may be stabilised with wires*
Dislocations: closed reduction and either neighbour strapping or wiring
