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SUMMED2 > ORTHO- Foot/Ankle > Flashcards

ORTHO- Foot/Ankle Flashcards

1
Q

What are secondary or primary injuries with MC inversion lateral ankle sprains?

A

peroneal tendon tear
subluxation, sprain of subtalar joint
FX base of the 5th MT
avulsion FX- ​anterior process of ​calcaneus or ​the lateral aspect of the​ talus

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2
Q

What are req. for XRay based off Malleolor zone in ottawa zone?

A

Bony TTP proxim fib head/ tip of lateral malleolus
Bony posteriol medial malleous 6cm
ER
NWB

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3
Q

What are req. for XRay based off Midfoot zone in ottawa zone?

A

**Always AP, Latral and oblique
Bone TTP base of 5th (prox to mortise jt)
Bone TTP navicular medial pain

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4
Q

What is rarely torn only if you dislocate ankle?

A

posterior talofibular lig

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5
Q

What is sig. laxity of both ATFL and CFL?

A

Grade 3

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6
Q

What happens in eversion ankle sprain?

A

Rare, Deltoid strong

If Deltoid torn- NEEDS surgery, d/t lack of repair

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7
Q

Pt has medial pain in ankle. Eccymosis 24hr later. What is important?

A 
***Xray carefully
Avulsion fracture of tibia
Olique FX of fibula
Lateral shift of talus
Sydnemosis rupture
REPAIR
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8
Q

If fibular FX BELOW mortise; Weber A classification

A

stable - weight bear as tolerated

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9
Q

What if fibular fx ABOVE mortise?

A

unstable -

ORIF- NWB!!

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10
Q

What is #1 cause of injury?

A

Prev injury
AKI
MRI if pn >8w

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11
Q

How do you treat a severe ANK

A 
Immobilize 3-4wk
WBAT w. cruthes
3wk ankle brace-wean
PT
8-12w to heal
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12
Q

When examiing ankle for fracture where do you start and what should not forget?

A

Start proximally
Check neuro
Check pulses

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13
Q

WHat is the MC common tear ligament in Ankle Sprain?

A

Grade I Pops is Anterior talofibulare ligament
Grade II ATF and CF mild
Grade II ATF, CF severe lax
PF MC in dislocation

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14
Q

What would indicate jt instability?

A

Medial pain
Review Xray closely: lateral shift of talus, obligue fx of fibula
Deltoid lig strung avulse malleous

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15
Q

When should you get an MRI?

A
  1. Severe instability >8wk w/ pain
  2. Peroneal tendon injury
  3. Osteochondral defect
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16
Q

What are the goals of treatment?

A

RICE, NSAIDs, PT
MILD- WBAT ankle brace 3-4w
Severe- Immobiliz 3-4w CAM boot NWBAT splint
Transition to ankle brace 3w- 8-12wks

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17
Q

What are consider your **stable Fx?

A
  1. ONe malleolus and no LIGS
  2. NOn displaced
    TX- NWB cast 2. WBAT 4-6wk healing form DOI
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18
Q

What are the unstable FX that need referral?

A
  1. Displaced- surgery
  2. Maisonneuve FX Both side of ankle jt BiL malleolus
  3. Deltoid LIG
  4. Widen mortise
    TX- ORIF
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19
Q

How do people fx their Talus?

A 
**High energy trauma.
Fall from ht
Extreme DF
MC talar neck
CP- Mod ankle swelling 2. Varus valugs deform
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20
Q

What is concern with talar neck fx of talus?

A

Avascular necrosis- 60% is cartilage, lack of blood supply
CT and Xray 3 views
Neurovascular exam

21
Q

What is Hawkins classification?

A

Type 1 – fx through talar neck, no dislocation
10% risk of AVN

Type 2 – with a little bit of subluxation of the talar joint
40% risk of AVN

Type 3 – dislocation of talar dome
90% risk of AVN

Type 4 – type 3 plus talonavicular joint is also dislocated
100% risk of AVN

TX- ORIF

22
Q

What is Traumatic disruption of the tarsometatarsal joints: fracture, dislocation or both?

A

MIDFOOT FX
LISFRANC- sig trauma or indirect mech- Vertical load to food
Severe DAMAGE to 2nd Tarsometatarsal Jt- no CT holding 1st MT to 2nd MT
RISK- compartment syndrome, arthritis, instablity

23
Q

How is LISFRANC clinically dx?

A

Stablize hindfoot and rotate forefoo
+ for pain
W/U- Xra AP, lat, Oblique- WTB prn
XRAy DX- 2nd MT should line up with medial aspect of middle cuneiform. Shift = Lisfranc injury.
4th MT should line up with medial cubiod surface. Shift = Lisfranc injury

24
Q

What is treatment of LISFRANC?

A

NOn displaced NWB cast 8wk. Rigid arch support 3m

Displace >2mm- ORIF- Remove fixation after 6 months with custom rigid orthotic for 6 additional months

25
Q

Pt c/o swelling, TTP in 1st MT jt. from twisting on the turf?
ON PE- Providing axial load produces pain. What is this?

A

Metatarsal FX
W/U Xray- 3 views
TX- supportive self resolving
NON Displaced- Short Leg Cast or CAM walker and WBAT
XR again @ 6 weeks
Surgery maybe if 4mm displace or 10deg angulation

26
Q

What is MC fracture of BASE of 5th?

A

Avulsion Fracture of 5th Metatarsal Styloid (Pseudo-Jones)
Poor prognoiss
PT- AROM and PROM early

27
Q

THis tendon pulls on base of 5th causing this pain?

A 
Short Peroneal Brevis Brisol tendon
CP- TTP swelling
DX- XR 3 veiw
TX- CAM boot, P/o shoe WBAT 4-6w
1. REchck XR 6 wks- firm soled
2. Again 6k-, if healing regular shoe
28
Q

This occurs when landing on side of foot with trauma?

A

JONES FX- Fracture in the proximal metaphysis of 5th metatarsal (metaphyseal-diaphyseal junction)
RISK- nonunion d/t low blood supply

29
Q

What is TReatment plan with Jones fX?

A

NWB 6wk. Referral to surgeon regarding progression

30
Q

What is MC in endurance runners at 5th?

A

Stress FX distal toward shaft

31
Q

Aunt Bunny jammed her toe on the coffee table. C/o throbbing after, swollen, TTP.

A

Phalangeal FX
DX-XRay 3 view
Tx-Buddy tape + P/O shoe 4-6wk for 1st toe
GREAT Toe Displaced FX- Referral

32
Q

Caron felt this pop after being a weekend warrior in calf, after sudden force planterflexion What is initial management for this injury?

A 
Achilles Tear
VC M 30-50y
DX- Thompson test- DEC planter flexion
TX- Surgery 1st 2wk or NON op cast 8-10w
1. CAM Boot 5wk

Partial Tear- Immoblize NWB cast, walker boot 4-6w in plantarflx

33
Q

What is characteristic of Achilles Tear?

A
  1. Pop, walking on sand, weak

2. Palpable defect 3-6cm proximal to insertion-poorest blood supply

34
Q

Post stable fx pearls include?

A
  1. Fx swelling noteablley. XRay recheck 12-14d
  2. Cast, WB or NWB, CAM walker, Hard sole shoe, buddy or splint
  3. RTn 4wk Xray
  4. 8-10wk healing,
35
Q

Post unstable Fx pearls..

A
  1. RTN 1-3d Xray
  2. Immobilized NWB cast or Splint d/t swellling
  3. RTN 1w alignment chekc
  4. 4-6w cast removed prn, WB or NWB prn
    5 12-14w healing
36
Q

When is true evidence of bone healing?

A

4-6w

37
Q

Where does Ankle arthriitis occur?

A

Gradual onset
Degradation of cartilage btwn talus and tibia-mortise
Eti- PMH injury, obese, RA
DX- 3 veiw Xray- narrowed jt

38
Q

What is CP of Ankle OA?

A

Mod to sever swelling
Warmth
TTP
Dec ROM PF and DF

39
Q

How do you treat Ankle OA?

A
  1. CAM, AFO, Intra-articular steroid inj
  2. Surgery- Ankle replacement- Preserves ankle ROM
    Ankle arthrodesis fusion- for obese, laborers, failed TX. LOSS of ROMM
40
Q

I woke up this morning the the following:

Heel pain, gets better, the worse at end of day. H/o long stride, weak R Glute

A

Plantar Fasciitis

Eti- degenerative tear_inflammation bone and fascia. Tight and Weak posterior ankle

41
Q

What is the tX for Plantar Fascia?

A
  1. RICE
  2. Stretching and massage 3-4x/day
  3. Orthotic heel pad
  4. NSAIDs
  5. Night splint (loosen sheets) slight DF
  6. CAM 4wk
42
Q

Where do you inject corticosteroid?

A 
medial calcaneal tuberosity
Adv. to hit bone and inj 3ml
While W/D cont to inject 2ml
4ml lidocaine/1ml corticosteroid
6-12m to fully reslove
43
Q

What is 2/2 to plantar fasicits?

A

Heel spurs
Calcification depostis at medial calcaneal tuberosity
DX- Xray
TX- underlying cause. NOT the spur

44
Q

What is cause of women wearing tight cute shoes?

A

Painful Bunions
Hallus valugs- lateral deviation of great toe at 1st MTP jt
DX- Clinical and XRAy AP for angle
TX- widebox shoes. Surgery is PAINFUL- referr

45
Q

Pt c/o burning forefoot pain and sensation in feet in high heels and aerobics. Sometimes feels as if she is walking on a marble? What is DDX

A

Morton Neuroma- Perineural fibrosis d/t irritaion of the common digital nerve as it passes between metatarsal heads of 3-4toes
TX- Wide, soft, low heels 2. Metarsal pad 3. Cortison inj- inj plantar aspect proximal to MT Heads.
Refer if persist.

46
Q

How do you DX Mortons Neuroma?

A

Pencil press btwn 2-3, 3-4 MT heads, while squeezing forefoot MT heads together
+= pain plantar aspect
DDX- callus, metarsalgia, DM, synovitis, arthitis

47
Q

What is difference btwn corn and callus?

A

Eti ecxessive pressure, gait, deformity, stiffness, shoes
Corn: hyperkeratotic lesion formed on a toe ,soft or hard
Callus: hyperkeratotic lesion formed anywhere but a toe

48
Q

Who have high risk of corn or callus?

A

DM pt- infection

TX- paring down, gait analysis, PT shoe fitting, donut pad

SUMMED2 (38 decks)

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