MSK Ankle teaching Flashcards
what classification system can be used for lateral malleolar fractures
Weber’s classification can be used for lateral malleolar fractures.
Type A occurs below the level of the syndesmosis, type B at the level of syndesmosis, and type C above.
Type C are more unstable in nature and generally always require surgical fixation.
apart from webers classification what other classification tool can be used in ankle fractures
Lauge-hansen classification is more commonly used.
The first word is used to describe the position of the foot at the time of injury, then the second word is used to describe the direction of the deforming force.
according to the Ottawa ankle rules what would determine that someone requires an ankle XR
point tenderness at posterior edge (of distal 6 cm) or tip lateral malleolus
point tenderness at posterior edge (of distal 6 cm) or tip medial malleolus
inability to weight bear (four steps) immediately after the injury and in emergency department
according to the Ottawa ankle rules what would determine that someone requires foot series XR
point tenderness at the base of the fifth metatarsal
point tenderness at the navicular
inability to weight bear (four steps) immediately after the injury and in emergency department
how could an ankle fracture present
pain
may be unable to bear weight
obvious deformity.
Can have open fractures or fractures with neurovascular compromise
what position must the foot be in when taking ankle XRs
dorsiflexion; this is because the talus, which is narrower posteriorly, can appear translated within the mortise when the ankle is plantarflexed.
when would it be inappropriate to use the ottawa ankle rules
patient is intoxicated or uncooperative
has other distracting painful injuries
has diminished sensation in their legs
or has gross swelling.
Also ensure to follow up in 5-7 days if pain and swelling has not improved.
Use with caution in children.
what is the managment for ankle #s
unless there is an open fracture, all fractures require urgent and immediate reduction, typically done in ED under sedation.
Post reduction checking neurovascular status is important.
Post reduction below the knee backslab should be fitted, and XR repeated to ensure there is adequate reduction.
when would ORIF be used in ankle fractures
Displaced bimalleolar or trimalleolar fractures
Weber C fractures
Weber B fractures with talar shift
Open fractures
what are complications of ankle fractures
post-traumatic OA (risk reduced if appropriate management performed).
For those who’ve required ORIF then there is also risk of DVT, infection, malunion, and metal work prominence
requires adequate physio to reduce risk of chronic ankle pain
what is a potts fracture
Uni or bimalleolar fracture
Often due to inversion or eversion injury or axial loading onto the foot, often occur in jumping or twisting sports. Inversion injuries occur more commonly due to the weaker ligaments around the lateral ankle.
what is osteochondral damage
Damage to the cartilage of the joint, this leads to fluid entering the bone and causing oedema. Can lead to degenerative changes in the joint. Most common cause is trauma which causes the chondral surface to impact with other bones leading to damage
how do you manage osteochondral damage
usually detected by MRI.
First line treatment would be physio and analgesics.
next line tend to be platelet rich plasma (PRP), prolotherapy (PrT), or cortisone injections.
If joint injections don’t relieve symptoms then arthroscopic debridement should be considered.
how do you manage a ‘sprained ankle’
ottawa ankle rules to determine if XR is needed.
conservative treatment (rest, analgesia, ice, keeping the leg raised and physio).
supportive boot, or immobilizing cast may be used if tear is large
If failure to respond to conservative management or severe instability then surgical repair may be used.
what is a complication of an severe ankle sprain
complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. Over time, this instability can result in damage to the bones and cartilage, the smooth lining of the joint
