Lecture 7 Flashcards

1
Q

Ottawa rules for ankle x-rays

A
  • Pain in the malleolar zone and one of the following:
  • Bone tenderness at posterior edge or tip of lateral malleolus (distal 6 cm)
  • Bone tenderness at posterior edge or tip of medial malleolus (distal 6 cm)
  • Inability to bear weight immediately and in the ER for 4 steps
  • (Bearing weight counts even if there is a limp)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ottawa rules for foot x-rays

A
  • Pain in the midfoot zone and one of the following:
  • Bone tenderness at base of 5th metatarsal
  • Bone tenderness at the navicular
  • Inability to bear weight immediately and in the ER for 4 steps
  • (Bearing weight counts even if there is a limp)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical judgement can overrule concrete rules. The following can prevent adequate palpation:

A
  • Altered foot/ankle sensation
  • Large amounts of swelling
  • Other painful injuries
  • Altered mental state of patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment of lateral ankle sprain with avulsion fracture of 5th metatarsal tuberosity

A
  • Usually conservative with protected weightbearing boot/cast
  • Surgery may be warranted depending on degree of displacement of fractured fragment or % of articular surface involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5th metatarsal tuberosity (styloid process)

A
  • Atttachment of fibularis brevis and lateral band of plantar aponeurosis
  • Well vascularized
  • Avulsion fracture can result from inversion ankle injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Have to differentiate avulsion fracture from

A
  • Other 5th met frx
  • Apophysis
  • Os vesalianum (.1-1% prevalence)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Apophysis of the 5th metatarsal

A
  • 2ᵒ ossification center
  • Normally seen ages 10-16 yrs
  • Appears 12 yrs boys and 10yrs girls
  • Fuses within 2-4 years after appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Apophysis of the 5th metatarsal is located

A
  • Laterally

- Oriented longitudinally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most commonly fractured metatarsal

A
  • 5th metatarsal

- Tuberosity most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Proximal fractures of 5th metatarsal

A
  • Tuberosity (zone 1): avulsion fractures
  • Metaphysis/metadiaphyseal jxn (zone 2): Jones fractures
  • Proximal diaphysis (zone 3): stress fractures
  • All cause lateral foot pain and difficulty walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tuberosity (zone 1): avulsion fractures

A
  • Also known as pseudo-Jones fractures
  • Plantarflexion inversion injury
  • Well vascularized by multiple metaphyseal arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Metaphysis/metadiaphyseal jxn (zone 2): Jones fractures

A
  • Transverse frx through the base (~1.5-3cm from tuberosity tip)
  • Caused by forefoot adduction
  • Can occur when pivoting and foot rolls onto the lateral border
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Jones fractures are susceptible to

A
  • Nonunion and delayed union
  • Watershed area of blood supply between:
  • Nutrient artery that enters and supplies the diaphysis
  • Metaphyseal vessels that supply the apophysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Jones fracture treatment requires

A
  • Periods of non-weightbearing

- Often require surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Proximal diaphysis (zone 3): stress fractures

A
  • Caused by repetitive microtrauma
  • Susceptible to delayed union and nonunion
  • Requires period of non-weightbearing, often surgical intervention is required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Iselin disease

A
  • Traction apophysitis of 5th metatarsal tuberosity

- Atraumatic, repetitive traction of fibularis brevis tendon at its attachment site

17
Q

Iselin disease most commonly seen in

A
  • Boys and girls ~ age 10-14 who are physically active and/or participate in sports
  • Sports with inversion stresses (soccer, baskeball, dancing, etc) and running/jumping
18
Q

Iselin disease clinical appearance

A
  • Patient will present with lateral foot pain with activity
  • Pain with eversion and plantar flexion
  • Swelling and tenderness over 5th metatarsal tuberosity
  • X-rays may show an irregular or fragmented apophysis
  • Usually treated conservatively