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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
Pt c/o swelling, TTP in 1st MT jt. from twisting on the turf? ON PE- Providing axial load produces pain. What is this?
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
What is MC fracture of BASE of 5th?
Avulsion Fracture of 5th Metatarsal Styloid (Pseudo-Jones) Poor prognoiss PT- AROM and PROM early
27
THis tendon pulls on base of 5th causing this pain?
``` 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
This occurs when landing on side of foot with trauma?
JONES FX- Fracture in the proximal metaphysis of 5th metatarsal (metaphyseal-diaphyseal junction) RISK- nonunion d/t low blood supply
29
What is TReatment plan with Jones fX?
NWB 6wk. Referral to surgeon regarding progression
30
What is MC in endurance runners at 5th?
Stress FX distal toward shaft
31
Aunt Bunny jammed her toe on the coffee table. C/o throbbing after, swollen, TTP.
Phalangeal FX DX-XRay 3 view Tx-Buddy tape + P/O shoe 4-6wk for 1st toe GREAT Toe Displaced FX- Referral
32
Caron felt this pop after being a weekend warrior in calf, after sudden force planterflexion What is initial management for this injury?
``` 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
What is characteristic of Achilles Tear?
1. Pop, walking on sand, weak | 2. Palpable defect 3-6cm proximal to insertion-poorest blood supply
34
Post stable fx pearls include?
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
Post unstable Fx pearls..
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
When is true evidence of bone healing?
4-6w
37
Where does Ankle arthriitis occur?
Gradual onset Degradation of cartilage btwn talus and tibia-mortise Eti- PMH injury, obese, RA DX- 3 veiw Xray- narrowed jt
38
What is CP of Ankle OA?
Mod to sever swelling Warmth TTP Dec ROM PF and DF
39
How do you treat Ankle OA?
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
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
Plantar Fasciitis | Eti- degenerative tear_inflammation bone and fascia. Tight and Weak posterior ankle
41
What is the tX for Plantar Fascia?
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
Where do you inject corticosteroid?
``` 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
What is 2/2 to plantar fasicits?
Heel spurs Calcification depostis at medial calcaneal tuberosity DX- Xray TX- underlying cause. NOT the spur
44
What is cause of women wearing tight cute shoes?
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
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
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
How do you DX Mortons Neuroma?
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
What is difference btwn corn and callus?
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
Who have high risk of corn or callus?
DM pt- infection | TX- paring down, gait analysis, PT shoe fitting, donut pad

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