Lower Limb Injuries Flashcards
What is the classification of lateral malleolar ankle fractures and what is it based on?
Weber’s classification
Fibula fractures
It is based on the relation of the fracture to the syndismosis.
Describe the classification of lateral malleolar ankle fractures? (+ mechanism)
Weber’s:
A: sub syndismosis
Mechanism: SAD (supination and adduction)
B: syndismotic
Mechanism: SEX (supination and external rotation)
OR
PAB (pronation and abduction)
C: supra syndismotic
Mechanism: PEX (pronation external rotation)
Describe the stability and management of the different lateral malleolar ankle fractures?
Weber’s A = Stable. 6 weeks plaster of paris
Weber’s B = Stable/Unstable dependent on whether the deltoid ligament (medial) is intact
50% conservative
50% surgery (depends on talar shift)
Weber’s C = Unstable
Always need open reduction and internal fixation
What is a sign of ankle fracture on an Xray?
Talar shift.
Moves laterally.
Normally should be a symmetrical amount of joint space around the talus if the space is assymetrical suggests there has been a fracture.
In an ankle fracture which area is it also important to look for a fracture? What is this type of fracture called?
Proximal fibula as the force may have radiated up the fibula.
Masoner #
Why is reduction so important in ankle fractures?
As it helps to reduce the swelling.
If there is too much swelling may cause fracture blisters, this makes open reduction impossible due an incresed infection risk.
In this scenario an external fixator may be needed.
What is a pilon fracture?
It is a severe fracture of the distal tibia cause by a fall from a height on to the ankle.
Note: same mechanism of action as a calaneal fracture.
How may a meniscal tear present?
Pain and tenderness
Swelling
Locking if there is a loose fragment
Giving way
History of trauma.
What is the mechanism of action of a meniscal tear?
Rotational force causing shearing of the meniscus
Describe the vascularity of the meniscus?
Red zone (peripherally) to white zone (centrally).
Red zone is vascular and therefore will heal.
Red/white zone has some vascular supply therefore may heal.
White zone is avascular and therefore will not heal.
Describe the management of meniscal tears?
Conservative treatment if not painful and not causing issues.
Surgical:
Trimming loose cartilage for symptomattic relief
Repair if in white or maybe white/red zone
Note: much higher threshold for trimming cartilage from the lateral meniscus as it is more important to prevent OA due to the shape of the lateral plateau.
How are the ligmenatous injuries of the knee managed?
MCL and LCL are treated non operatively if in isolation.
PCL is rarely operated as it is close to the popliteal aa making the surgery difficult and risky.
ACL can be treated conservatively but is often operated on in younger patients that are active. The ACL is reconstructed using a graft from the hamstring or patellar tendon (more painful)
Name the ankle malleoli that can be fractured?
medial, lateral and posterior malleolus (formed by posterior tibia)
bimalleolar fracture: fractures 2/3
trimalleolar fracture: 3/3
Describe the Salter Harris classification of ankle fractures?
What are the ottowa ankle rules?
Potential ankle fractures should warrant investigation if:
- patient is unable to weight bear
- pain and tenderness over:
- medial or lateral malleolus
Potential foot fractures should warrant investigation if:
- patient is unable to weight bear
- pain and tenderness over:
- 5th metatarsal or navicular
