NEED TO FINISH MSK: Ankle Sprain, Distal Radius Fracture, Hip Fracture & Shoulder Disclocation

Question 1

What is a sprain?

Answer 1

A stretching, partial or complete tear of a ligament.

Question 2

What can an ankle sprain be divided into?

Answer 2

1) high ankle sprain: involving the syndesmosis

2) low ankle sprain: involving the lateral collateral ligaments.


Question 3

What does a high ankle sprain involve?

Answer 3

The syndesmosis

Question 4

What is the syndesmosis joint of the ankle?

Answer 4

A syndesmosis is a a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments.

In the ankle, this involves the ligaments binding the distal tibia & fibula at the distal tibiofibular syndesmosis (google picture).

The syndesmosis in the ankle is comprised of the:
a) anterior inferior tibiofibular ligament (AITFL)
b) posterior inferior tibiofibular ligament (PITFL)
c) and the intra-osseous membrane.

Question 5

What are the 3 bony components of the ankle joint?

Answer 5

1) distal tibia
2) distal fibula
3) superior aspect of the talus

Question 6

What structure binds the distal tibia and fibula together?

Answer 6

The syndesmosis

Question 7

What 4 things is the syndesmosis of the ankle composed of?

Answer 7

1) anterior inferior tibiofibular ligament (AITFL)

2) posterior inferior tibiofibular ligament (PITFL)

3) interosseous ligament (IOL)

4) interosseous membrane.

Question 8

What secures the distal fibula to the talus?

Answer 8

The anterior and posterior talofibular ligaments (ATFL and PTFL)

Question 9

What secures the distal fibula to the calcaneus?

Answer 9

The calcaneofibular ligament.

Question 10

What are the anterior talofibular, posterior talofibular and calcaneofibular ligaments collectively known as?

Answer 10

The lateral collateral ligament complex (LCL)

Question 11

What is the distal tibia secured to the talus by?

Answer 11

Deltoid ligament

Question 12

What does a low ankle sprain involve?

Answer 12

Lateral collateral ligaments (ATFL, PTFL and calcaneofibular).

The anterior talofibular ligament being injured most commonly.

Question 13

Are high or low ankle sprains more common?

Answer 13

Low (>90%): with injury to the ATFL the most common offender

Question 14

Low ankle sprains typically occur following what injury?

Answer 14

Inversion injury on a plantarflexed foot.

Question 15

Clinical features of a low ankle sprain?

Answer 15

1) pain, swelling & tenderness over affected ligaments

2) sometimes bruising

3) patients usually able to weight bear unless severe

Question 16

Presentation of a high ankle sprain?

Answer 16

1) Patients frequently find weight-bearing painful in comparison to low ankle sprains.

2) Pain when the tibia and fibula are squeezed together at the level of the mid-calf (Hopkin’s squeeze test).

Question 17

Imaging of choice in an ankle spray?

Answer 17

Plain XR to rule out any bony injury.

Question 18

What is the usual mechansim of injury in a high ankle sprain?

Answer 18

external rotation of the foot causing the talus to push the fibula laterally.

Question 19

What % of ankle sprains are associated with fracture?

Answer 19

10%

Question 20

Investigations in ankle sprain?

Answer 20

1) XCR

2) MRI if persistent pain and useful for evaluating perineal tendons.


Question 21

management of low ankle sprains?

Answer 21

1) Non-operative with rest, ice, compression and elevation (the so-called RICE protocol).

2) Occasionally a removable orthosis, cast and/or crutches may be required for short-term symptom relief.

Question 22

Management of high ankle sprain?

Answer 22

1) If no diastasis then non-weight-bearing orthosis or cast until pain subsides.

2) If diastasis or failed non-operative management then operative fixation is usually warranted.