S3_L3 Trauma to the Ankle and Foot Flashcards
Modified TF
A. Diagnostic ultrasound is used to determine tendon thickness, character, and presence of a tear.
B. It can also provide valuable information on the quality of torn ends to help make surgical repair decisions.
TT
Modified TF
A. The ankle and foot are the most frequently injured major joints of the body.
B. Ankle x-rays are the most frequently ordered studies in the ER.
TT
Modified TF
A. The Ottawa Ankle and Foot Rules are radiographs should be ordered after ankle or foot trauma if the patient is unable to bear weight AND has point tenderness either in the malleolar zone, midfoot zone, base of the 5th metatarsal, or the navicular.
B. These are 100% sensitive to detecting significant fractures.
TT
Modified TF
A. Ankle inversion injuries comprise 75% of all traumatic conditions at the ankle.
B. Injuries may vary from minor overstretching of ligaments to ligamentous rupture or avulsion creating instability and significant functional deficits.
FT
A. Ankle inversion injuries comprise 85% of all traumatic conditions at the ankle.
Modified TF
A. Fracture dislocations are the most severe type of injury.
B. Inversion sprains are more common than eversion sprains.
TT
Modified TF
A. Inversion sprain is caused by stress damage at the lateral collateral ligaments.
B. The ATFL and CFL are the most commonly injured.
TT
Modified TF
A. The ATFL is injured by landing on an inverted foot.
B. The CFL is injured by landing on a plantarflexed and inverted foot.
FF
A. The ATFL is injured by landing on a plantarflexed and inverted foot.
B. The CFL is injured by landing on an inverted foot.
Modified TF
A. Eversion sprain is caused by stress damage at the medial collateral ligaments.
B. It is associated with bony damage due to avulsion injuries.
TT
NOTE: Bony avulsion occurs more commonly than ligament tear in eversion sprains
Modified TF
A. Fracture of the medial malleolus and fracture of the lateral malleolus with rupture or avulsion of the medial collateral ligament are common injuries due to eversion stress.
B. Fracture of the medial malleolus is the most common injury.
TT
TRUE OR FALSE: The Maisonneurve fracture is due to a torn deltoid ligament, disrupted interosseous membrane on the lateral side of the joint, and a spiral fracture at the proximal fibula.
True
Modified TF
A. Tendon pathology is the most common condition evaluated at the ankle and foot.
B. The MOI may be direct trauma or by overuse.
TT
Impingement Syndrome types
- affects distal tibiofibular syndesmosis
- affects posterior tibial region
- affects anterolateral gutter
A. Anterolateral ankle impingement
B. Syndesmotic impingement
C. Posterior ankle impingement
- B
- C
- A
Microtearing within the tendon with subsequent healing by disorganized collagen, resulting in less tensile strength than healthy collagen
A. Tenosynovitis
B. Stenosing tenosynovitis
C. Tendinitis/Tendinopathy
D. Tendinosis
E. Tendon rupture
D. Tendinosis
NOTE: Increased signal within the tendon that does not get fluid bright on T2
Complete tear requiring surgical repair. On axial view, shows missing tendons.
A. Tenosynovitis
B. Stenosing tenosynovitis
C. Tendinitis/Tendinopathy
D. Tendinosis
E. Tendon rupture
E. Tendon rupture
NOTE: Achilles tendon is the most common tendon in the LE that requires surgical repair
Fluid in the tendon sheath surrounding a normal tendon
A. Tenosynovitis
B. Stenosing tenosynovitis
C. Tendinitis/Tendinopathy
D. Tendinosis
E. Tendon rupture
A. Tenosynovitis
Development of adhesions in the tendon sheath that prevents normal gliding of the tendon
A. Tenosynovitis
B. Stenosing tenosynovitis
C. Tendinitis/Tendinopathy
D. Tendinosis
E. Tendon rupture
B. Stenosing tenosynovitis
Partial tears of the tendon, focal or fusiform swelling with high signal within the tendon on T2 weighted images. It is the attenuation or thinning of the tendon that precedes complete rupture.
A. Tenosynovitis
B. Stenosing tenosynovitis
C. Tendinitis/Tendinopathy
D. Tendinosis
E. Tendon rupture
C. Tendinitis/Tendinopathy
Plantaris and achilles tendon; partial tears of the Achilles tendon are very common
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
A. Posterior tendon pathology
Weekend warrior refers to the aging (>40) athlete who plays intermittently and suffers this injury because older tendons have decreased blood supply, low tensile strength, and less flexibility.
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
A. Posterior tendon pathology
Peroneus brevis and longus (principal evertors) are often injured during inversion sprains (longitudinal tears) because these evertors try to counteract the inversion forces.
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
C. Lateral tendon pathology
NOTE: The retinaculum holding the tendons may be disrupted causing the tendons to chronically sublux over the fibula and cause abnormal friction
Tibialis posterior, flexor digitorum longus, flexor hallucis longus; Tom Dick and a very nervous Harry
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
D. Medial tendon pathology
Tibialis posterior rupture common in rheumatoid arthritis, causes flat footedness; FHL is susceptible to tenosynovitis in ballerinas due to repetitive and extreme plantarflexion (en point)
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
D. Medial tendon pathology
Tibialis anterior, extensor hallucis longus, extensor digitorum longus and peroneus tertius; seldom affected by pathologies; tibialis anterior tendinitis can be seen in uphill runners
A. Posterior tendon pathology
B. Anterior tendon pathology
C. Lateral tendon pathology
D. Medial tendon pathology
B. Anterior tendon pathology
Modified TF
A. Surgical treatment for pes cavus includes soft tissue and bony procedures, tendon transfers, osteotomy, plantar fascia releases, and joint arthrodesis.
B. Tightness is common in the plantar fascia in pes cavus.
TT
Modified TF
A. Hallux rigidus is complete loss of motion of the big toe.
B. Hallux limitis is partial loss of motion at the great toe, and flexion, extension, abduction, adduction are limited.
TT
Modified TF
A. Rehabilitation for phalangeal fractures is important to reestablish normal dorsiflexion of the 1st toe which allows for normal gait.
B. Complications of this type of fractures are hallux limitus and hallux rigidus.
TT
Modified TF
A. Forefoot fractures’ MOI: Metatarsal fractures result from direct trauma
B. Complications include non-union,
delayed union, and posttraumatic arthritis.
TT
Modified TF
A. In navicular fractures, radiographs identify most fracture lines.
B. Stress fractures are best defined by MRI when radiographs are negative.
TT
The ff are the 4 types of navicular fractures, except
A. Plantar avulsion fractures at the site of the attachment of the deltoid ligament
B. Tuberosity fractures
C. Body fractures
D. Stress fractures
E. None
A. Plantar avulsion fractures at the site of the attachment of the deltoid ligament
A. Dorsal avulsion fractures at the site of the attachment of the deltoid ligament
Modified TF
A. Treatment for navicular fracture is immobilization in a short leg cast for 4-6 weeks.
B. Operative fixation is necessary for displaced fractures or avulsed fragments followed by partial weight bearing in a short cast.
TT
Modified TF
A. Navicular fractures can be stress fractures or avulsion fractures of its tuberosity due to its attachments.
B. The posterior tibial tendon and insertion of the springy ligament attach to the navicular tuberosity.
TT
Modified TF
A. Sinus tarsi syndrome is caused by inversion injury or repetitive impingement of the soft tissue and ligaments due to an excessively supinated foot.
B. Symptoms include a feeling of hindfoot instability and aggravation by weight-bearing activities.
A. Sinus tarsi syndrome is caused by inversion injury or repetitive impingement of the soft tissue and ligaments due to an excessively supinated foot.
A. Sinus tarsi syndrome is caused by inversion injury or repetitive impingement of the soft tissue and ligaments due to an excessively pronated foot.
Modified TF
A. In sinus tarsi syndrome, there is an area of pain and tenderness on the lateral side of the hindfoot originating from the sinus tarsus or the talocalcaneal sulcus, a tunnel between the calcaneus and talus.
B. The sinus is usually filled with the interosseous talocalcaneal ligament, which, when injured, usually with lateral or inversion ankle sprains, can lead to the characteristic pain the patient feels.
TT
Associated injuries with ankle sprains, except
A. Impingement syndrome
B. Sinus tarsi syndrome
C. Avulsion fractures
D. Tearing of the distal tibiofibular syndesmotic complex
E. Instability from sprains due to tearing of one or more of the principal stabilizing ligaments, allowing the mortise to widen
F. None
F. None
NOTE: Twisting of the foot is the usual cause of tearing of the distal tibiofibular syndesmotic complex
Ankle fracture classification
- Fracture of both malleoli
- Fracture of both malleoli and the posterior rim/margin of the tibia, which is sometimes called the third malleolus
- Fracture of either the lateral or medial malleolus
A. Unimalleolar
B. Bimalleolar
C. Trimalleolar
- B
- C
- A
Modified TF
A. MOI of ankle fractures is usually an axial/rotational loading.
B. Treatment complications include non–union and degenerative changes associated with post-traumatic arthritis.
TT
Resultant injury patterns of ankle fractures are based on the ff, except
A. Chronicity of preexisting ankle instability
B. Patient’s age
C. Bone density
D. Comorbidities related to bony conditions
E. Position of the foot during the time of loading
F. Magnitude, direction, and rate of loading
D. Comorbidities related to bony conditions
D. Comorbidities related to soft tissue conditions
Modified TF
A. Fractures of the foot are generally located at the hindfoot, midfoot, and forefoot.
B. Common fractures include fractures of the hindfoot and isolated fractures of the forefoot, metatarsals, and phalanges.
TT
Modified TF
A. The most frequently fractured tarsal is the calcaneus.
B. It is fractured from falls from a height and the individual lands on their feet, and the injury is often bilateral and frequently associated with thoracolumbar spine due to the impact.
TT
Modified TF
A. The talus is the second most commonly fractured tarsal bone.
B. It is fractured when a large force is applied to a plantarflexed foot, as when a driver slams into the brakes in an automobile collision.
TF
B. It is fractured when a large force is applied to a dorsiflexed foot, as when a driver slams into the brakes in an automobile collision.