Orthopedic Procedures- Foot And Ankle Flashcards
Co-morbidities to worry about
Diabetes, Vascular disease and smoking
Diabetic neuropathy- cause, complications, testing
Due to vascular insufficiency and nerve fiber loss
Stocking and glove pattern of sensory loss
Tissues get glycosylated, small tissues and nerves and BV’s don’t work- can’t feel lacerations–> infection/osteomyelitis
Test with Somme’s-Weinstein 5.07 monofilament
Compilation of neuropathy, continue to walk on fracture and it starts to fragment–> deformity in stage 4. Usually in mid-foot: rocket bottom deformity
Ulcer on prominence of deformity
Charcot Arthropathy
Radiographic Evaluation of ankle
AP, mortise X ray (fibular is set internally rotated about 15 degrees) and lateral
Should be standing
Distal tibiofibular joint relationship- slightly movable fibrous joint
When insulted= high ankle sprain
Syndesmosis
Bimalleolar ankle fracture
Twisting mechanism, energy goes up through lateral ligaments, breaking off lateral malleolus, moves back and breaks off medial malleolus
A trimalleolar ankle fracture also involves what?
Posterior malleolus displacement
Syndesmotic disruption with proximal fibula fracture- name and mechanism
Maisonneuve injury
Twisting mechanism, energy comes up through interosseous membrane and ends up in fibula
Just Correct syndesmosis
Really bad ankle fracture, higher energy, articular involvement, almost always treated in a staged fashion
Pilon fracture
Take out fracture, try to get fusion, shortened tibia, distraction osteogenesis, turn clickers over time to gain length: Ankle arthrodesis with proximal tibia lengthening
Ankle Arthritis- cause, treatment
Primary arthritis is rare- usually post traumatic
Mediations, injection, bracing
Gold standard is arthrodesis= fusion, subchondral bone exposed, wait for it to heal
arthroplasty may be an option- takes out a lot of bone
Extra bone that sometimes develops being the talus connected by a fibrous band- can by symptomatic (posterior ankle pain)
Os trigonum
High energy ankle fracture- look for associated spine injury
Involvement of posterior facet (subtalar joint)
CT is essential to look at this joint
Name and symptoms
Serious complication of this fracture
Calcaneus fracture- subtalar joint controls inversion and eversion of hindfoot, hard to walk on uneven surface if this joint is disrupted
Avulsion of Achilles- bone is pushing on skin: will Necrose through skin easily: emergency surgery
High energy forced dorsiflexion ankle injury
Has poor blood supply because it has no tendinous attachments
Name and complications
Talus fracture- most common in neck (can also fracture head, body, processes of talus)
Two Bv’s supply talus and usually one is disrupted when fractured= avascular necrosis
Dislocation or fracture of the tarsometatarsal joint, usually involved 1st and 2nd MTs (can dislocate all 5 metarsals laterally)
Can be purely ligamentous
Name and treatment strategy
Lisfranc injury- don’t want to rigidly fix lateral border because there is a lot of motion here, medial column realigned will fix lateral column with it
Can use Kay wires percutaneously to fix lateral metatarsals
Lateral deviation of great toe on first metatarsal
AKA bunion
Toe rotates, pronates, sesamoids move, etc
Name, complications, treatment
Hallux Valgus- medial eminence usually symptomatic, 2nd toe crowding/hammering
*have to address deformity at joint level and at metatarsal level
Congenital flexible flatfoot Adult acquired flatfoot caused by: Presents as: Stages: Treatment:
Pes planovalgus
In adults caused by posterior tibial tendon insufficiency (usually supports the arch)
Pain over posterior tibial tendon, deformity of ‘too many toes’ sign when standing (see toes laterally from behind), inability to do single limb-heel rise
Different stages- pain without deformity (stage 1), pain with flexible deformity, pain with fixed deformity, all of the above and resultant ankle arthritis/deformity (stage 4)
Early- PT, meds, bracing/unloading of PTT
Flexible deformity- FDL transfer, medial side calcaneal osteotomy, lateral column lengthening
Fixed deformity- triple arthrodesis
Very high arched feet
Name, cause, presentation, treatment
Cavovarus- very rigid (unlike flexible planovalgus)
Usually neurological in nature: Charcot-Marie Tooth disease, cerebral palsy, stroke
Posterior tibial and fibularis longus tendon overpull causing hindfoot varus and forefoot valgus
Lateral foot and ankle pain
Can develop stress fractures
Standing exam shows cavus alignment- peek a boo heel align (heel is to the midline instead of to valgus like in flatfoot)
Coleman block test
Flexible- orthotics to correct deformity
Spasticity- tendon transfers to move deforming forces (Bridle procedure)
Rigid- lateralizing calcaneal osteotomy or arthrodesis
