Foot/Ankle

Question 1

Classifying sprains: Grade 1

Answer 1

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

Question 2

Classifying sprains: Grade 2

Answer 2

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

Question 3

Classifying sprains: Grade 3

Answer 3

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

Question 4

Clinical Exam

Talar Tilt Test

Answer 4

• tests ATFL and CFL

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

Question 5

Clinical Exam

Anterior Drawer Test

Answer 5

• tests ATFL

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

Question 6

Lateral ankle stability can be divided into _____ and _____.

Answer 6

Functional stability

mechanical stability

Question 7

functional instability

Answer 7

complaint of patient, “my ankle rolled”

patient lacks radiographic and clinical evidence

Question 8

mechanical instability

Answer 8

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

Question 9

Peroneus Tertius Tendon
origin:
insertion:

Answer 9

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

Question 10

Peroneus Longus Tendon
origin:
insertion:
job:

Answer 10

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

Question 11

Peroneus Brevis Tendon
Origin:
Insertion:
Job:

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Retinaculum

Answer 13

thin anatomic structures that provide fulcrum and control tendon gliding

Question 14

PTFL

Answer 14

Posterior Talofibular Lig (lateral ankle lig)

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

Question 15

CFL

Answer 15

calcaneofibular lig (lateral ankle lig)

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

Question 16

ATFL

Answer 16

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

Question 17

what does the ATFL resist?

Answer 17

resists anterior translation of talus

-resists inversion during plantarflexion

Question 18

Features and benefits of Titanium plates

Answer 18

• 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

Question 19

what material is best for people with nickel allergies?

Answer 19

Titanium

Question 20

Titanium ankle fracture screw caddy comes with:

Answer 20

• 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

Question 21

Titanium Ankle Fracture set comes with:

Answer 21

• 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

Question 22

Stainless steel plating options for ankle fracture:

5

Answer 22

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

Question 23

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

Answer 23

for comminuted fibula shaft fractures, overweight or larger athletes

Question 24

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

Answer 24

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

Question 25

Ankle Fracture MGMT System: What do surgeons consider for an ankle fracture procedure?

Answer 25

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

Question 26

Syndesmotic Assesments: (5)

Answer 26

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

Question 27

Ankle Syndesmosis: | Mechanism of injury-

Answer 27

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

Question 28

Ankle Syndesmosis: | Mechanism of injury- what ligament tears first and then what ligament is typically followed?

Answer 28

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

Question 29

Ankle Syndesmotic Function:

Answer 29

- keeps integrity between tibia and fibula | - naturally widens 1 mm during weight bearing

Question 30

Ankle Syndesmotic Function resists what movements?

Answer 30

- coronal translation of fibula - rotational movement - sagittal translation

Question 31

Talar Osteochondral injuries

Answer 31

- with an ankle fracture up to 100% of fractures have degree of osteochondral injuries

Question 32

Danis-Weber Classification: | Weber C-

Answer 32

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

Question 33

Danis-Weber Classification: | Weber B-

Answer 33

- 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

Question 34

Danis-Weber Classification: | Weber A-

Answer 34

- Infrasyndesmotic - running and roll ankle laterally - fracture to fibula below the joint line - typically syndesmotic ligaments are not involved

Question 35

Lauge-Hansen Ankle Fracture classification

Answer 35

based on mechanism of injury and position the ankle was in

Question 36

Danis-Weber Ankle Fracture Classification

Answer 36

- much simpler way to classify ankle fractures - based on level of fibular fracture - better for surgical decision making

Question 37

3 typical x-ray views:

Answer 37

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

Question 38

Medial Ankle Osteology: | Calcaneus

Answer 38

- Sustentaculum Tali

Question 39

Medial Ankle Osteology: | Talus

Answer 39

head supported by calcaneus and spring ligaments

Question 40

``` Medial Ankle Osteology: Medial Malleolus (3) ```

Answer 40

1. anterior colliculus 2. posterior colliculus 3. intercallicular groove

Question 41

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

Answer 41

``` 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)

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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

Question 44

what makes up the inferior tibiofibular joint?

Answer 44

the Ankle syndesmosis

Question 45

what makes up the Ankle Mortise?

Answer 45

-tibia, fibula and talus