Tibial Shaft, Ankle and Foot Trauma Flashcards
Tibial fractures are the most common cause of what, after trauma?
Particularly which part of the leg?
Tibial fractures are the most common cause of compartment syndrome, especially the anterior compartment
What degree of displacement and angulation can be tolerated when determining whether or not a tibial fracture requires surgery?
How are these fractures managed non-operatively?
Up to 50% displacement and 5 degrees angulation can be tolerated when managing a tibial fracture non-operatively
Management is conservative and an above-the-knee cast is used
How does co-fracture of the fibula affect the drifting of the tibia?
The the fibula is unfractured, the tibia tends to drift into varus
If the fibula is also fractured, the tibia tends to drift into valgus
How are tibial fractures typically managed operatively?
Usually managed with surgical stabilisation via IM nailing
(ORIF has a higher degree of non-union, and external fixation has risks with pin site infections)
The tibia is one of the (fastest/slowest) healing bones in the body
How long does a tibial fracture typically take to recover?
Tibia is one of the slowest healing bones in the body
Typically can take 16 weeks for union to occur but may take up to a year to recover
What is a Pilon fracture?
How are they typically caused and how are they best managed?
Intra-articular fracture of the distal tibia
High energy fractures, typically caused by falling from height or sudden deceleration
These are surgical emergencies and are treated rapidly with ORIF
(ankle arthrodesis may also be required for post-traumatic OA)
Which ligaments are most commonly injured in an ankle sprain?
The lateral ankle ligaments (anterior and posterior ligaments, as well as the calcaneofibular ligament
What scoring criteria is used in A&E to determine if a suspected ankle fracture requires an Xray?
What merits an Xray?
The Ottowa criteria
Any severe localised bony tenderness of the distal tibia or fibula, or inability to weight bear for 4 steps merits an Xray
What distinction needs to be made between ankle fractures that guides treatment?
How is this disinction made and what treatment options are there?
Is the ankle fracture stable or instable
Stable = deltoid ligament intact, treat with a walking cast or a splint for 6 weeks
Unstable = deltoid ligament ruptured, usually requires ORIF
What is the prognosis of a calcaneal fracture dependent upon?
What possible complication may occur?
Calcaneal fracture prognosis is dependent on whether the subtalar joint is involved, as well as the degree of comminution
There may be substantial soft tissue swelling and compartment syndrome may occur
In a calcaneal fracture, in which direction does the heel tend to drift?
What does this cause?
The heel tends to drift in a valgus position
This causes impingement of the lateral ankle tendons
What complication may develop in a talus fracture if there is displacement of the fracture or subluxation/dislocation of the talus?
How are talar fractures managed?
The talar body is at high risk of AVN
Open or closed reduction and screw fixation
What is a Lisfranc fracture/dislocation?
Fracture of the base of the 2nd metatarsal, associated with a dislocation of the base of the 2nd metatarsal, with or without dislocation of the other metatarsal joints
Patients present with a grossly swollen/bruised foot and are unable to weight bear
How are Lisfranc fracture/dislocations managed?
Untreated, can cause considerable pain and disability
Closed or open reduction, followed by screw fixation
