T&O - Lower Limb Flashcards
Describe the bones typically affected in an ankle fracture.
The four bony parts of the ankle affected in an ankle fracture are the medial malleolus, lateral malleolus, tibial plafond (or pilon), and talus.
Identify the demographic groups most commonly affected by ankle fractures.
Ankle fractures are more common in younger males and older females.
State the percentage of all fractures seen in the trauma setting that are ankle fractures.
Ankle fractures account for around 10% of all fractures seen in the trauma setting.
Define the bones that make up the ankle joint.
The ankle joint consists of the talus, tibial plafond, medial malleolus (distal end of the tibia), and lateral malleolus (distal end of the fibula).
Explain the function of the syndesmosis in the ankle.
The syndesmosis is a fibrous structure that joins the tibia and fibula, consisting of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and the interosseous membrane.
Describe a Pilon fracture and how it differs from other ankle fractures.
A Pilon fracture involves the tibial articular surface (the plafond) and is considered a separate injury due to its complexity.
How are ankle fractures classified anatomically?
Ankle fractures can be classified as isolated lateral malleolar fractures, isolated medial malleolar fractures, bimalleolar fractures (medial + lateral malleolus), and trimalleolar fractures (medial + lateral + posterior malleolus).
Describe the Weber classification for ankle fractures.
The Weber classification describes fractures of the lateral malleolus, categorized as follows: Type A = below the syndesmosis, Type B = at the level of the syndesmosis, and Type C = above the syndesmosis. Higher injury types indicate a greater risk of ankle instability.
Define the Lauge-Hansen classification.
The Lauge-Hansen classification is used in orthopaedic practice to describe ankle fractures based on the position of the ankle at the time of injury and the forces involved, providing more detail than the Weber classification.
How do patients typically present with ankle fractures?
Patients often present with ankle pain following trauma, and deformity is common, especially in cases of fracture dislocations. Ankle fractures may also show signs of neurovascular compromise, particularly in open fractures.
What are the signs of neurovascular deficit associated with ankle fractures?
Signs of neurovascular deficit may include issues with the small peroneal nerve, coldness, pulselessness, paraesthesia, and both motor and sensory deficits.
Explain the Ottawa Ankle Rules.
The Ottawa Ankle Rules indicate that radiographs are necessary if there is bone tenderness at the posterior edge or tip of the lateral or medial malleolus, or if the patient is unable to bear weight both immediately and in the emergency department for four steps. These rules are not applicable if the patient is intoxicated, uncooperative, or has other distracting injuries.
What imaging is required for suspected ankle fractures?
For suspected ankle fractures, standard radiographs are typically required to assess the extent and nature of the injury.
Describe the views required for plain radiographs in ankle fractures.
Both AP (anteroposterior) and lateral views are required for plain radiographs in ankle fractures.
Explain the significance of dorsiflexion during ankle radiographs.
Dorsiflexion is important to prevent the talus from appearing translated within the mortise, as it can be misaligned in a plantarflexed position.
Outline the initial management steps for ankle fractures.
Initial management includes immediate fracture reduction under sedation, placement in a below-knee back slab, checking post-reduction neurovascular status, and repeating radiographs to ensure proper alignment.
Identify when conservative management is appropriate for ankle fractures.
Conservative management is appropriate for non-displaced medial malleolus fractures, Weber A fractures, Weber B fractures without talar shift, and for patients unfit for surgery.
List conservative treatment options for stable ankle fractures.
Conservative treatment options include casts (backslab or full) or a controlled ankle motion walker boot, which allow for weight-bearing while limiting ankle movement.
Determine when surgical management is necessary for ankle fractures.
Surgical management is required for displaced bimalleolar or trimalleolar fractures, Weber C fractures, Weber B fractures with talar shift, and open fractures.
Describe the common complications that can arise from ankle fractures.
Common complications include post-traumatic arthritis, surgical site infections, deep vein thrombosis (DVT), pulmonary embolism (PE), neurovascular injury, non-union, and metalwork prominence in cases requiring open reduction and internal fixation (ORIF).
Define the key points in managing ankle fractures.
Ankle fractures are classified into isolated malleolar fractures, bimalleolar fractures, and trimalleolar fractures. Management may be conservative or surgical, depending on the type of fracture.
How can ankle sprains be differentiated from ankle fractures?
Ankle sprains are ligamentous injuries characterized by swelling and pain but do not involve bony fractures. They can be classified into high ankle sprains (syndesmotic injury) and low ankle sprains (ATFL and CFL injury).
What is the treatment approach for ankle sprains?
Most ankle sprains are managed conservatively with analgesia, ice, elevation, and early mobilization. Radiographs are used to rule out any bony injury.
