Sprain

Question 1

Management of Grades 1 and 2 sprains

Answer 1

Rest the injured part for 48 hours, depending on severity
Ice pack for 20mins every 3-4 hourse when awake for the first 48 hours
Compression badage
Elevate to hip level to minimise swelling
Analgesics
Review in 48 hours, then in 7 days
Special strapping

Question 2

When to encourage weight bearing

Answer 2

Partial weight bear with crutches for 48 hours/until standing no longer painful
Encourage early full weight bearing and a full range of movement with isometric exercises
Use warm soaks, dispense with ice packs after 48 hours.
Aim towards full activity by 2 weeks.

Question 3

Which ligaments of the ankle are prone to sprain injury

Answer 3

Medial and lateral ligaments

Question 4

In what position do most sprains happen

Answer 4

When the ankle is plantar flexed and inverted

Question 5

Clinical features of sprained lateral ligament

Answer 5

Ankle gives way
Difficulty in weight bearing
Discomfort
Bruising indicates more severe injury->may take 12-24 hours
May have functional instability

Question 6

Physical examination of sprained ankle

Answer 6

Note swelling and bruising
Palpate over bony landmarks and three lateral ligaments
Test general joint laxity and range of movement
Note rounded swelling in the front of the lateral malleolus
Test stability in AP plane

Question 7

Where do you need to be mindful of a fracture

Answer 7

Lateral malleolus or base of fifth metatarsal

Question 8

What imaging may be required

Answer 8

Xray
MRI
US for non ligament

Question 9

Describe the Ottawa foot and ankle rules

Answer 9

Ankle radiographs are only required if there is pain in the malleolar area and any one of the following:
Bone tenderness over the distal 6cm of the posterior edge or tip of the lateral malleolus
Bone tenderness over the distal 6cm of the posterior edge or tip of the medial malleolus
Inability to weight bear immediately and in the Emergency Department

Foot radiographs are only required if there is pain in the midfoot area and any one of the following:
Bone tenderness at the base of the fifth metatarsal
Bone tenderness at the navicular bone
Inability to weight bear immediately and in the Emergency Department

Question 10

When do the Ottawa rules not apply

Answer 10

Pregnant women
Head injury w/ diminished ability to follow test
Intoxicated with diminished ability to follow the test
Children