Week 3 Task Sheet - Leg Fractures Flashcards
What type of fracture healing occurs in the lateral malleolus?
Direct healing
What are the 5 stages of direct healing?
- Haematoma formation
- The proliferation of osteogenic cells at the # site
- ICM laid down by osteoblasts - mainly calcium and collagen
- Calcification of the matrix
- bone-strengthening along the lines of stress - by cutting cones
What is the difference between direct fracture healing and secondary fracture healing?
no cartilage model
no callus formation
Take the same amount of time
How does a lateral malleolus fracture usually occur?
trip or fall - combined inversion and adduction
What ligaments could be damaged during a lateral malleolus fracture?
interosseous lig
anterior tibiofibular lig
posterior tibiofibular lig
transverse fibular lig
What are the attachments of the interosseous ligaments?
short fibrous bands running the length of the tibia and fibular - preventing displacement
What are the attachments of the anterior tibiofibular ligament?
borders of the fibular notch on the tibia to the anterior surface of lateral malleolus
What are the attachments of the posterior tibiofibular ligament?
borders of the fibular notch on the tibia to the posterior surface of lateral malleolus
What are the attachments of the transverse fibular ligament?
from the posterior surface of the lateral malleolus to the posteroinferior tibia and its malleolar fossa
What are the 3 lateral collateral ligaments of the ankle?
posterior talofibular ligament
calcaneofibular ligament
anterior Talofibular ligament
What are the attachments of the posterior talofibular ligament?
the posterior border of the lateral malleolus to the lateral/posterior tubercle of talus
What are the attachments of the anterior talofibular ligament?
anterior border of the lateral malleolus and the neck of talus
What are the attachments of the calcaneofibular ligament?
tip of lateral malleolus to lateral calcaneus behind the peroneal tubercle
How does mobilisation help with stiffness?
Stressing collagen fibres through the yield point into the plastic range - causing breakage of collagen cross-links and allowing plastic deformation and an overall increase in tissue length
Why do patients feel pain following mobilisation?
causing micro-trauma to the soft tissues - triggers an inflammatory response - this then triggers proliferation and remodelling to the new length.
Since we are causing inflammation - there will be an increase in inflammatory cytokines = nociceptor stimulation
What are potential complications of a lateral malleolus fracture?
- decreased ROM - due to adhesions
- dislocation of peroneal tendons
- CRPS
- disturbance in gait
- instability
What amount of ankle movement is required for normal walking?
20 degrees DF
50 degrees PF
What are the muscle groups of the calf?
anterior crural group
posterior crural group
lateral crural group
What muscle are within the anterior crural group?
Tibialis Anterior / Extensor Hallucis Longus / Extensor digitorum longus / Peroneus Tertius
What muscle is within the posterior crural group?
Superficial : Gastroc / Soleus / Plantaris
Deep : Popliteus / Flexor Hallucis Longus / Flexor Digitorum Longus / Tibialis posterior
What muscles are in the lateral crural group?
Peroneus Longus / Peroneus Brevis
Why is there swelling following immobilisation?
Lack of muscle pump action in a cast - normally, there is capillary filtration and resorpsion of interstital fluid, there is movement fluid back into the capillaries and towards the heart aided by the muscle pump - doesnt happen = retained interstitial fluid in immobilised tissues
