Foot and Ankle trauma

Question 1

what cause ankle (soft tissue) sprains?

Answer 1

• 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)

Question 2

presentation of ankle sprian?

Answer 2

-takes longer to resolve than a fracture
- pain
- bruising
- tenderness

Question 3

what is the management of an ankle sprain?

Answer 3

non-surgical: RICE (rest, ice, compression and elevation) physiotherapy surgical - Brostrum Gould - Chrisman Snook

Question 4

What is the cause of ankle fracture?

Answer 4

common usually a result of twisting forces (usually inversion or twisting on a planted foot)

Question 5

what determines need for x-ray in ankle injury?

Answer 5

Ottawa criteria
- severe localised tenderness (bony tenderness) of the distal tibia/fibula, or inability to weight bear for four steps

Question 6

what is the classification of ankle fractures?

Answer 6

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

Question 7

what does talar shift/ tilt on AP x-ray mean?

Answer 7

Deltoid ligament ruptured

Question 8

what is the prognosis of talar shift?

Answer 8

Ankle-joint contact pressure greatly increases&raquo_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

Question 9

what is a bimalleolar ankle fracture?

Answer 9

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

Question 10

what is a calcaneal fracture?
Cause
Prognosis

Answer 10

Cause: fall from height onto heal
Prognosis: dependent on extent of the involvement of the subtalar joint and the degree of comminution

Question 11

what is a talar fracture?Cause?

Answer 11

What: forced dorsiflexion with dislocationof talus or dislocation of the fracture
Cause: RTA/ aircraft crash
-High risk of AVN reduction

Question 12

what is a midfoot (lisfranc) fracture/dislocation?

Answer 12

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

Question 13

what is the investigation of a midfoot (lisfranc) fracture/dislocation?

Answer 13

can be missed on x-ray if in doubt CT

Question 14

how does midfoot (lisfranc) fracture/ dislocation presenT?

Answer 14

grossly swollen bruised foot unable to weight bear (be wary if x-ray looks normal)

Question 15

how is a midfoot (lisfranc) fracture/ dislocation managed?

Answer 15

closed/open reduction with fixation using screws

Question 16

what is a 5th metatarsal fracture?

Answer 16

Fracture of base of 5th metatarsal

Normally due to inversion injury + avulsion fracture at insertion of the peroneus brevis tendon

Question 17

how should 5th metatarsal fractures be managed?

Answer 17

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)

Question 18

who gets 1st metatarsal fractures?

Answer 18

they are uncommon because it is strong and thick important so normally fixed

Question 19

what is a lesser metatarsal fracture?

Answer 19

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

Question 20

what is a 2nd metatarsal fracture?

Answer 20

a common site for stress fracture can occur spontaneously or after period of increased exercise/activity

Question 21

how is a 2nd metatarsal fracture managed?

Answer 21

Cast until pain subsides

Question 22

what is the management for a toe fracture?

Answer 22

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