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General Onboarding > Foot/Ankle > Flashcards

Foot/Ankle Flashcards

1
Q

Classifying sprains: Grade 1

A

slight stretch/damage to fibers of ligament, most common ATFL sprain

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2
Q

Classifying sprains: Grade 2

A

partial tear of ligament, laxity of joint is present, ATFL and CFL

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3
Q

Classifying sprains: Grade 3

A

complete tear of ligament, instability, ATFL, CFL and possibly PTFL

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4
Q

Clinical Exam

Talar Tilt Test

A
  • tests ATFL and CFL

- Calc/talus held and tilted to inversion, tibia is stable in neutral/dorsiflexion

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5
Q

Clinical Exam

Anterior Drawer Test

A
  • tests ATFL

- ankle held neutral or 10 degrees of plantar flexion calcaneus pulled anteriorly while tibia is stable

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6
Q

Lateral ankle stability can be divided into _____ and _____.

A

Functional stability

mechanical stability

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7
Q

functional instability

A

complaint of patient, “my ankle rolled”

patient lacks radiographic and clinical evidence

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8
Q

mechanical instability

A

clinical and radiographic evidence demonstrates excess movement of talus with in ankle mortise

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9
Q

Peroneus Tertius Tendon
origin:
insertion:

A

origin- anterior aspect of inferior fibula
insertion- midshaft of 5 MTS
anatomical landmark for scope ankle
lateral portal for anterior ankle scope lateral to peroneus tertius

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10
Q

Peroneus Longus Tendon
origin:
insertion:
job:

A

origin- fibular head and proximal 2/3 of fibula
insertion- lateral aspect of plantar surface of medial cuniform, base of 1st MTS

Job- evert foot

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11
Q

Peroneus Brevis Tendon
Origin:
Insertion:
Job:

A

(muscle tendon complex)
origin- distal 3rd of lateral aspect of fibula
insertion- base of 5th MTS
job- evert/abduct foot

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12
Q

There are 2 extensor retinaculum in the ankle (superior / inferior).
Inferior Extensor Retinaculum

A

-used often when repairing the lateral ankle ligament to bolster repair

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13
Q

Retinaculum

A

thin anatomic structures that provide fulcrum and control tendon gliding

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14
Q

PTFL

A

Posterior Talofibular Lig (lateral ankle lig)

  • resists posterior translation on talus
  • not clinically important
  • not repaired if torn
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15
Q

CFL

A

calcaneofibular lig (lateral ankle lig)

  • 2nd most important ligament in lateral ankle
  • primary lateral stabilizer of subtalar joint
  • resists inversion during dorsiflexion
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16
Q

ATFL

A

anterier talofibular lig (lateral ankle lig)
most important- inferior band

-primary ligament stabilizer of ankle
(can look like 2 ligaments but it is a bundle

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17
Q

what does the ATFL resist?

A

resists anterior translation of talus

-resists inversion during plantarflexion

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18
Q

Features and benefits of Titanium plates

A
  • VAL screws: allows screws to cut into plate
  • tightrope cut out: TR button sits flush
  • compression hole: plate to be tweaked
  • allows combo of soft tissue and hardware fixation
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19
Q

what material is best for people with nickel allergies?

A

Titanium

20
Q

Titanium ankle fracture screw caddy comes with:

A
  • 3.0 mm VAL (variable angle)
  • 3.0 mm Cortical
  • 3.5 mm locking
  • 3.5 mm non locking
  • 4.0 mm cancellous
  • 4.0 mm cannulated short thread
21
Q

Titanium Ankle Fracture set comes with:

A
  • 7 right locking distal fibula plates
  • 7 left locking distal fibula plates
  • 7 straight plates
  • 7 1/3 tubular plates
  • vereval locking guide for 3.0 screws
22
Q

Stainless steel plating options for ankle fracture:

5

A
  1. locking distal fibula plate (complex fib plate)
  2. lateral malleola hook plate
  3. medial malleola hook plate
  4. 3,5 reoncstruction plate
  5. 1/3 tubular plate
23
Q

when would you want to use a 3,5 stainless steel reconstruction plate?

A

for comminuted fibula shaft fractures, overweight or larger athletes

24
Q

what is the most common stainless steel plating option for a fibula shaft fracture?

A

1/3 tubular plate- very low profile, used in most fibula fractures, comes in 4-12 hole lengths

25
Q

Ankle Fracture MGMT System:

What do surgeons consider for an ankle fracture procedure?

A
  1. classify injury
  2. stable patterns ( non operative treatment)
  3. unstable patterns ( operative treatment, no skin issues)
  4. Deltoid incompetence (obvious medial clear space widening )
  5. open/irreductible injury
26
Q

Syndesmotic Assesments: (5)

A
  1. cotton test (open technique)
  2. fibular translation
  3. external rotation stress test
  4. arthroscopic exam
  5. fibular translation
27
Q

Ankle Syndesmosis:

Mechanism of injury-

A

-forced external rotation of foot, occurs with or without fracture of fibula

28
Q

Ankle Syndesmosis:

Mechanism of injury- what ligament tears first and then what ligament is typically followed?

A

AiTFL usually tears 1st, then interosseous ligament, then PiTFL

29
Q

Ankle Syndesmotic Function:

A
  • keeps integrity between tibia and fibula

- naturally widens 1 mm during weight bearing

30
Q

Ankle Syndesmotic Function resists what movements?

A
  • coronal translation of fibula
  • rotational movement
  • sagittal translation
31
Q

Talar Osteochondral injuries

A
  • with an ankle fracture up to 100% of fractures have degree of osteochondral injuries
32
Q

Danis-Weber Classification:

Weber C-

A
  • Suprasydesmotic
  • fracture of fibula occurs above joint line , syndesmotic ligaments are torn
  • common to have a fracture dislocation
  • more serious
33
Q

Danis-Weber Classification:

Weber B-

A
  • Transyndesmotic
  • roll ankle medially
  • fracture of fibula starts @ joint line and moves proximally (eversion injury is not as common)

-we do not know if syndesmotic ligaments are torn

34
Q

Danis-Weber Classification:

Weber A-

A
  • Infrasyndesmotic
  • running and roll ankle laterally
  • fracture to fibula below the joint line
  • typically syndesmotic ligaments are not involved
35
Q

Lauge-Hansen Ankle Fracture classification

A

based on mechanism of injury and position the ankle was in

36
Q

Danis-Weber Ankle Fracture Classification

A
  • much simpler way to classify ankle fractures
  • based on level of fibular fracture
  • better for surgical decision making
37
Q

3 typical x-ray views:

A
  1. Anterior Posterior View (AP)
  2. Mortise View (20 degree internal rotation)
  3. Lateral View
38
Q

Medial Ankle Osteology:

Calcaneus

A
  • Sustentaculum Tali
39
Q

Medial Ankle Osteology:

Talus

A

head supported by calcaneus and spring ligaments

40
Q 
Medial Ankle Osteology:
Medial Malleolus (3)
A
  1. anterior colliculus
  2. posterior colliculus
  3. intercallicular groove
41
Q

Deltoid Ligament is the _____ ankle joint. and has ___ ligaments.

A 
Medial ankle joint and has 6 ligaments
Superficial Ligaments (4)
1. tibionavicular ligament
2. tibiospring ligament
3. tibiocalcaneal lig (most important)
4. superficial posterior tibiotaltar ligament

Deep ligaments (2)

  1. Deep posterior tibiotalar ligament (strongest of 2)
  2. Deep anterior tibiotalar ligament (most important)
42
Q

Lateral ankle ligament is the ______ ankle joint and has ___ ligaments.

A

Talofibular joint and has 3 ligaments.

  1. anterior talofibular ligament (ATFL) - most important most commonly injured
  2. Calcaneofibular ligament (CFL)
  3. posterior talofibular ligament (PTFL) - least important
43
Q

What is the Ankle Syndesmosis comprised of (bones and sturcture) and the supporting ligaments?

A
  • medial distal fibula and notched lateral tibia
    1. Anterior inferior tibiofibular lig (AiTFL)
    2. Posterior inferior Tibiofibular ligament (PiTFL)
    - strongest
    3. Tibiofibular interosseous ligament
44
Q

what makes up the inferior tibiofibular joint?

A

the Ankle syndesmosis

45
Q

what makes up the Ankle Mortise?

A

-tibia, fibula and talus

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