Sprained ankle

Question 1

what is the most common mechanism of injury in sprained ankle?

what will this cause?

what other type of sprain is there?

Answer 1

• 85% of cases are inversion
• damage to anterior talofibular ligament + lateral malleolus
• syndesmotic (high ankle) sprain caused by dorsiflexion

Question 2

how can ankle sprains be classified?

Answer 2

• grade 1: mild ligament damage, no joint damage
• grade 2: partial ligament tear, stretched until loose
• grade 3: complete tear, joint instability, ankle bruising

Question 3

how might they present?

Answer 3

• painful swollen ankle

- unable to weight bear

Question 4

how would you examine them?

what specific tests can you do?

Answer 4

• assess for neurovascular compromise
• Thompsons test: Achilles Test
• Anterior draw Test: tear of anterior talofibular ligament (cup ankle)
• Talar tilt: inversion stress test of calcaneofibular ligament
• Syndesmosis test: Squeeze test, interosseous membrane tenderness test
  external rotation stress test

Question 5

what are the Ottawa ankle rules?

Answer 5

• unable to walk 4 steps in ED or immediately after injury
• bony tenderness: 5th MT, Navicular, Posterior M/L malleolus
• foot X-ray instead if pain in mid foot

Question 6

what is the weber classification for ankle fractures?

Answer 6

• Type A: fracture of lateral malleolus distal to syndosmosis
• medial malleolus often fractured
• deltoid intact
• Type B: Fracture at syndesmosis
• syndesmosis remains intact
• medial malleolus fractured, deltoid may be torn
• Type C: fracture proximal to syndesmosis
• syndesmosis not intact, widening of tibiofibular articulation
• deltoid damage

Question 7

what is the difference in management between type A and then B and C?

Answer 7

• Type A: plastercast

- Type B/C: internal fixation

Question 8

how can a sprain be managed?

Answer 8

RICE:

• Rest
• Ice
• compression
• elevation
• if ligament fully ruptured then will require surgery