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SPMD3052 > WK9 - Acute Knee and Below Knee Injuries > Flashcards

WK9 - Acute Knee and Below Knee Injuries Flashcards

1
Q

Considerations of sports knee injuries.

A
  • most common sports injury
  • frequently misdiagnosed
  • can lead to early arthritis
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2
Q

What is the immediate field management of knee (and other sporting) injuries?

A

-Effective on-field management requires systematic approach for injury recognition, response and referral

TOTAPS
* Talk
* Observe
* Touch
* Active movement
* Passive movement
* Skills

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3
Q

What is the management of knee injuries?

A
  • rapid Ax
  • rapid Tx
  • rapid rehabilitation

^most athletes want RTP ASAP

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4
Q

What is the Hx for knee injuries?

A

Swelling
- immediately –> blood within joint, hemarthrosis
- in period after

Snap
- ACL? Any significant ligament injuries

Looking
- to orthopedic surgeon: hear knee locks and unlocks “came undone” –> mobility of the athlete

Give Way
- not just ligamentous rupture, could also refer to atrophied muscles causing knee to collapse

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5
Q

What to examine after checking Hx of knee injury?

A
  • Leg exposed/bare
  • Effusion (fluid within joint // may need to sweep hand back and forth to see where the fluid is)
  • Tenderness
  • ROM (pain, EXT/FLEX)
  • Ligament and meniscal tests
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6
Q

What to look for considering tenderness during examination?

A
  • pain (what areas?)
  • checking along joint lines and along bones
  • tenderness along MED joint line could point to MED joint pathology/meniscal tear
  • tenderness of MED joint along collateral ligament line could also indicate ligament injury
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7
Q

What to look for considering ligament and meniscal during examination?

A
  • tenderness
  • manoeuvre into full FLEX and adding motion
    -McMurrary’s Test –> palpable and audible clunk can indicate meniscal tear
  • placing strain on various ligaments and looking for laxity (ACL, PCL, MCL)
  • shift test –> ACL, checking for shift in ROT attitude of tibia during loaded FLEX and EXT
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8
Q

List a few specific knee injuries.

A
  • MED ligament tear (one of the most common)
  • ACL
  • PCL
  • meniscal tear
  • patella instability and dislocation
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9
Q

What is the cause and signs of MCL injuries?

A

Acute valgus force (distal limb away from body)
- knee in EXT, MED ligament torn, LAT compartment compressed

Signs of MED lig Tears
-Medial pain and swelling in region of medial ligament
-No significant effusion
*MCL sits just outside synovium thus blood doesn’t accumulate within joint
-Tender over MCL insertion on femur or tibia
*May have joint line tenderness – the line of MCL that is painful
-May have laxity on stressing
*Joint opening allows for classification

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10
Q

What are the classifications for MCL injuries?

A

I –> MJL opens <5mm
* Unlikely that significant damage has occurred

II –> MJL opens 5-10mm
* Partial disruption of fibers
* When opening up joint, there’s an end point to it
* Capacity for ligament to function well in future

III –> MJL opens >10mm
*When opening up joint, no end point

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11
Q

What is the Tx for MCL injuries?

A

I –> RICE, splint for pain
*Should be able to walk on leg, maybe have compression bandage
II –> Quad drills early
*RTP 4-6 weeks
*If not that severe, it is okay to RTP early as long as their muscles/knee are still in good condition
III –> look for other injuries
*Common to have g3 MCL with associated with ACL or even ACL, PCL
*For just MCL, occasionally may need surgery but rarely need surgical repair because it is difficult to repair
*Conservative treatment for MCL will work just as well as operative unless associated with other injuries

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12
Q

What is the cause of ACL tears?

A

side step, jumps, tackle
- puts high stress on ACL, when reaches shear stress limit
- tibia subluxes forward

Mya hear snap/pop
May feel knee “slip out of joint”

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13
Q

What are the signs of ACL tears?

A

-Knee swells quickly (<24h)
-hemarthrosis
*Big swollen knee after acute injury is 70% likely to have torn ACL
-Lack full extension (by a few degrees)
*Torn fibers of ACL have flipped into intercondylar notch and jammed it

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14
Q

How to test for ACL tear?

A

Lachman’s sign
*Knee bent to 15 degrees
*Pull forward on tibia, back on femur
*Look for translational movement

Pivot Shift Sign
*More complex test
*Patient relaxed
*Flex and extend knee with valgus force

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15
Q

What is the Tx for ACL injuries?

A
  • RICE
  • quad drills early
    –> quads can atrophy very quickly
  • orthopedic Ax early on
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16
Q

What are the consequences of ACL tears?

A

Shorter term
*50% lose a meniscus in 3y
Once you lose meniscus, higher rate/risk of osteoarthrosis
ACL reconstruction reduces risk of meniscal loss to about 10% in 3y

Long term
*Osteoarthritis

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17
Q

What are the effects of ACL reconstruction? Consider long and short term.

A

Short term
*Restores stability
*protect menisci from damage

Longer term
*Prevent osteoarthritis? Does it really prevent?

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18
Q

What are the indications for ACL reconstruction?

A

-Most people
-Symptomatic instability

*Giving way because of the rupture
-Repairable meniscal tear with ruptured ACL
*Repair both together
*Just repairing meniscal tear invites higher failure rate of meniscal repair

-Young person with ACL tear

-Anybody intending to remain very active
*Athletes
*General population that wants mobility

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19
Q

What is the ACL reconstruction technique?

A

Arthroscopic surgery
*Hamstring – semitendinosus and gracilis
*Screw fixation
*Autograft vs allograft (auto is own patient’s tissue, allo is donor tissue)

Auto is preferred

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20
Q

How long for ACL rehabilitation and recovery? Consider results of the surgery.

A

*1 night in hospital
*2 weeks in brace on crutches then return for consultation before walking
*3-4 months before running
*7-9 months before RTP
Longer periods before RTP to decrease reinjury rates
Ensure dynamics and biomechanics are working well

Results
*95% stable in daily activities
*90% RTP
Not everybody goes back
*Arthritis – long term outcome
*Revision rate (require second surgery)

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21
Q

What are the characteristics of PCL injuries?

A

-Less common injury
-Rarely results in significant instability
-Strength program (conservative) instead of surgery
-2-3 months before RTP

-Signs are similar to ACL
*Use Lachman’s test, anterior draw test, posterior sag test

-Ensure no other capsular injuries
*Medial ligament
*Posteromedial
*Combination injuries may require surgery

-Hamstring reconstruction rare

-Potentially dangerous area
*Tibial attachment right on the back and top of tibia
*Artery and nerve running outside joint capsule
*Reason why surgery not best option unless very necessary

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22
Q

What considerations are made for PCL reconstruction?

A
  • clear instability
  • associated with other ligament tears
  • only after good rehab has failed
  • usually successful
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23
Q

What is the mechanisms for meniscal tears? What are the signs?

A
  • twisting on planted foot
  • ROT forces cause shear stress to meniscous
    Signs
    -Doesn’t have significant swelling
    *Exceptions may be bucket handle tear
    -Localized joint line tenderness
    *Along meniscus
    -Locking or giving way
    -Meniscal stress tests
    *Pushing knee into flexion with various degrees of rotation
    *Produces pain at back of knee
    -MRI scan 95% accurate
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24
Q

What are the types of meniscal tears?

A
  1. Vertical tear –> progress to bucket handle tear
  2. radial tear –> progress to parrot beak tear
  3. horizontal tear –> flap tear

*bucket handle –> can put tear back together
* radial tear –> disrupted fibres, hardest to put back together, considered the worst

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25
Q

What is the Tx for meniscal injuries?

A

Operative intervention, arthroscopy especially for younger athletes
*Meniscectomy  Partial resection (removal)
6-8 weeks recovery
Create a smooth margin so weight-bearing does not cause pain

*Meniscal repair (preferred)
Recovery 2x of resection, 12-16w
First 4 weeks non-weight bearing in knee splint
Week 5-8, knee brace allows 0-90 degrees
*Avoid extreme movements (hyperflexion/extension) but allow strength building
–> After 8 weeks, agility training then another 4-6 weeks to get up to prior level

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26
Q

What is the mechanism and signs of patellar dislocation?

A

Females 10x more likely
Usually have an underlying predisposition

Mechanism
-Flexed knee under valgus loading (jumping)
Signs
-may stick out
-May reduce spontaneously
*Looks normal but swell afterwards
*Important to look at Hx/observation/patient description
-Lump visible on LAT side
*Patella does not naturally/usually displace MED ALWAYS LAT
-Knee flexed to about 20deg
-Tender MED side of patella
*When patella dislocates, tears MED patella retinaculum
-Knee swells rapidly
*Other cause of big swollen knee after injury (other one is ACL)

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27
Q

What is the Tx for patellar dislocation?

A

-May reduce with passive extension
*Eg if pick up leg while being carried off field
-Knee splint
*Only leave it on until they feel comfortable again
*Long term splinting is bad
-Should have early movement
-X-ray for loose fragment (or MRI)
*If a piece of patella gets knocked off during displacement
*Will need arthroscopic removal
-Commence quads drill early

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28
Q

What are the statistics for reinjury after patellar dislocation?

A
  • 50% chance after single dislocation of having another one
  • 90% chance of redislocation after 2nd one
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29
Q

What is patellar instability?

A
  • realignment is effective
  • tibial tubercle transfer –> move tibial tubercle (from LAT position) to change forces
    –> align mechanism of patellofemoral joint
    –> low rate of redislocation
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30
Q

What is the prevlaence ofl ower limb injuries below the knee?

A

1 in 5 players sustains an injury every season
- most common hamstrings, ankle, knees
- at least 1 previous injury/reduced lower limb function score has a significant increased risk of sustaining new injury of same kind during 8month follow-up period

*Important for us to RECOGNISE and REMOVE

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31
Q

What is the Ottawa ankle score?

A

OA Rules
- pain on dorsal side of 1 or both malleoli
- palpation pain at base of metatarsal 5
- palpation pain of navicular bone
-inability to walk at least 4 steps
- rule out fractures and reduce need for x-rays

Sensitivity –> 86-99%
specificity –> 25-46%

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32
Q

What is there to consider about the LAT side of the ankle in the Ottawa Ankle Scores?

A
  • more POS than ANT, around where ligament attaches
  • various attachments to one could cause periosteal disruptions and thus pain on palpation but may not be due to fracture
33
Q

What are the Utrecht Ankle Rules?

A

pain with axial compression is similar to putting weight on foot –> get xray
- swelling
-inability to weight bear
- deformity, instability, crepitating

RULES
4 - deformity, instability, crepitating
2 - inability to weight bear, axial compression pain
2 - tibia palpation pain and swelling
1 - fibula palpation pain and swelling
1- Achilles tendon palpation pain and swelling
1 - base of 5th metatarsal
1 - haematoma/haemarthrosis

Age divided by 10

Radiography required if >8 when added up
Sensitivity = 59%
Specificity = 84%

34
Q

What area do we also need to check following injuries to MED side of ankle?

A

LAT aspect of knee!

Maisonneuvre fracture (prox fibula)
- usually accompanies unstable ankle injury
–> force enters through ankle and travels up to fibular
- likely not weight-bearing, as it is a significant injury

35
Q

What does the ATFL of the ankle do? Consider injury.

A
  • controls AP draw, taut during PF (restrain against PF)
  • primary restraint against pathologic PF
  • 2 parts - 1 part is within synovium, usually does not heal well
  • if there is no pain on palpation of ATFL, unlikely there is actue LAT ligament rupture
36
Q

What is the role of the CFL in the ankle?

A

Calcaneofibular ligamnet
- runs below subtalar joint, holds subtalar joint
- controls inversion, taut in DF

37
Q

What is the role of PTFL in ankle?

A
  • comes into play with ankle dislocation

Does not have a lot to do with PF?

38
Q

What is the prevalence of ankle injuries? Consider injury, signs and diagnosis.

A

-60% of patients with acute LAS have pain on level of medial malleolus
-40% of patients with acute LAS have pain over AITFL without rupture of ligament (anterior inferior tibiofibular ligament)
-Delayed physical examination (4-5 days) is more reliable than physical examination within 48 hours
*In terms of specificity and sensitivity in diagnosing
*Allow for everything to settle
-Only ~50% of individuals who have a LAS will seek medical attention for it
-40% of individuals who sustain LAS will develop chronic ankle instability (CAI) and may not be able to RTP

39
Q

What is the ANT draw test?

A

-ATFL disrupted = excessive anterior movement compared to other side  positive anterior draw test
-Forward translation of talar dome relative to tibia
*Could potentially be due to old injuries
-Compared to healthy ankle
-Combination with other tests allows for degree of laxity to be determined
*Eg. Prone anterior draw test

40
Q

What to do during delayed examination of ankle injuries?

A

-Positive anterior drawer test + pain on palpation of ATFL and hematoma discoloration
*98% Sensitivity
*84% Specificity
-May not need expensive tests like MRI, CT, x-ray etc
-Ultrasonography has similar sensitivity (92%) but lacks specificity (64%) compared with delayed examination

41
Q

What is the healing process of ankle injuries? Consider duration as well.

A

Inflammatory phase (immediate)
Proliferative (6WKs-3months)
Remodelling phase (up to 1y post-trauma)

42
Q

What is the management of ankle injuries?

A
  • PRICE/RICE/POLICE
  • bracing // casting
43
Q

What is the recommendation of PRICE/RICE/POLICE managment?

A

*No evidence that RICE alone/cryotherapy/compression therapy alone has any positive influence on pain, swelling or patient function
-No role for RICE alone in treatment of acute LAS
*Joint cooling does not adversely affect muscle reaction time or muscle amplitude provided you don’t leave it on too long
*Cooling doesn’t affect other specific components of neuromuscular control such as joint position sense
*Ice can be applied before ankle rehab without adversely affecting dynamic control
-Effects should be limited to 10 minute applications of either wet-ice application or cold-water immersion

44
Q

What did the Lancet 2019 study find on bracing vs casting?

A

Lancet 2019 study on simple ankle strains
*The ones who did the best were those in plaster casts
-Min. 4wks in lower leg cast following acute LAS = less optimal outcomes compared with functional support and Ex strategies for 4-6wks
*Maybe max. 10-14 days immobilization, allow other professionals to determine recovery course of action
-Use lace-up or semi-rigid ankle brace = better outcomes compared to other functional types of treatment like sports tape or kinesiotape
*Good for immobilization and preventing reinjury

45
Q

What is the difference between Copers and Non-Copers in chronic ankle instability?

A

*Copers are those who suffered ankle sprains and have no residual symptoms
*Non-copers are those who suffer from CAI

46
Q

What are the implications of chronic ankle instability?

A
  • ankle corrects for small errors in faulty foot placement
  • hip corrects for larger errors in faulty foot placement
  • poor hip ADB/errors in hip mechanics will alter the way you land and increase likelihood of stress and inversion –> CAI
    –> shows how instability or problems at 1 level can affect the ankle
    –> injury at 1 level –> can’t control at subtalar joint
    –> need to work harder at hip but if can’t control at hip then leads to more ankle instability
47
Q

What is the difference between Copers and Non Copers: people with CAI vs healthy

A
  • ANT tibialis works less than half compared to healthy people
  • CAI people overuse the peroneus longus, MED gastroc and glute medius muscles compared to healthy people

** fibularis longus compensating for lack of ankle stability –> LAT compartment pain, fibularis longus tendonitis

** if muscles are not activating at the right time (e.g. too early in the swing phase) –> potentially more fatigue-aggravated ankle instability/laxity
^^ could be normalised with ankle bracing or taping

48
Q

What are the impacts of landing movements for ankle injuries?

A

-Achieving an equilibrium between the combined goals of stopping downward velocity of body and preventing collapse of lower extremity
-Increase hip flexion is one component of a preparatory strategy for CAI group to attempt to reduce risk of impact
-Eg jumping and landing on soft surface –> bend more to compensate for lack of ankle instability and balance
-Even if they don’t have pain but you notice them doing ^, may indicate CAI

49
Q

What are less common lower limb injuries below the knee?

A

LAT/Talar Dome Injuries (Mortise and Tenon Joint)
“OCD” fracture
* inversion with PF or atraumatic
- small piece that wasn’t fused on and is jamming/getting caught
- if people complain ankle is giving way but do not have hypermobility/ligamentous laxity, potentially have OCD

50
Q

What are the common movements that cause Lateral/Talar Dome Injuries?

A
  • inversion with PF or atraumatic (MED side)
  • inversion with DF
  • forced PF jamming (people who are consistently “on pointe”
  • point tenderness over LAT process (ANT and INF to the LAT malleolus) due to fracturing
  • fracture at neck of talus
  • fracture of ANT calcaneal process (articulates with cuboid) - not common
  • Jones fracture
  • overuse traction apophysitis
51
Q

Why are people who are consistently “on pointe” at risk of lateral/talar dome injuries?

A

*Tenderness to deep palpation anterior to Achille’s tendon over posterolateral talus instead of over Achille’s
*10% of population will experience, may be asymptomatic until plantarflexion
*Plantar flexion may reproduce pain

52
Q

What sport is point tenderness over LAT process related to?

A

“Snowboarders ankle” due to forces going through the area in the common snowboarding position
- may require surgical incision if there is non-union

53
Q

How does the fracture of the ANT calcaneal process (where it articulates with cuboid)?

A

Chopart Joint
-Between talonavicular and calcaneocuboid midfoot joint/Bifurcate joint between calcaneus, cuboid and navicular ??
-Part of joint process that holds up arch
-Many ligaments in this area
-Dorsal ligaments between cuboid and calcaneus
If ligaments are stretched, could cause disruption and an avulsion fracture

If ligaments are compressed, could cause compression fracture – fracture depends on joint movement
^ may be good to brace

54
Q

What are the ligaments of the Chopart Joint?

A
  • TN - talonavicular (top bony structure)
  • bifurcate ligament (middle)
  • DCC - Dorsal Calcaneocuboid Ligament (slightly below bifurcate ligament
55
Q

What is the Jones Fracture?

A

*Involves 4th and 5th metatarsal articulation
*Tendon of fibularis tertius and brevis are pulling in opposing directions

*Typically a stress fracture leading to a fracture
*If you miss this fracture, little chance of healing well
*Vascular considerations
-Zone 1 – avulsion not a big deal
-Zone 2 – articulating btw 4th and 5th, differential forces, poor blood supply, don’t heal very well
-Zone 3 – likely overuse, will break

56
Q

What is overuse traction apophysitis?

A

*Growth plate and avulsion in different directions
-Avulsion horizontal but growth plate is vertical
*Traction apophysitis of 5th MT
*Usually no surgical options, just conservative in boot
*Can take some time to show evidence of healing
-Clinical signs but radiologically not filled in yet

57
Q

The medial ankle requires a complex set of ligament to restrain multiple different movements. T or F

A

T!

MED collateral (deltoid) ligament attaches to the POS tibiotalar, tibiocalcaneal, tibionavicular and ANT tibiotalar

58
Q

When are the medial collateral (deltoid) ligaments activated?

A
  • ANT deltoid under max. tension when PF
  • mid portion of deltoid tension when hyperpronated
  • EXT ROT = deep deltoid ligament
  • ABD/Eversion = superficial deltoid ligament
59
Q

Where do medial ankle ligaments attach to?

A

tibia down to talus, navicular and sustentaculum tali

spring ligament ST to navicular –> sitting underneath, supporting talus/talonavicular head
* creates socket and support for head of talus
* most essential ligament in maintaining MED longitudinal arch

60
Q

List the ligaments from superior to inferior of the MED ankle

A
  1. Spring ligament
  2. Short plantar ligament
  3. long plantar ligament
  4. plantar aponeurosis
61
Q

List the function of the deltoid ligament?

A
  • Provide med stability to tibiotalar joint by providing a firm fixation between tibia and talus
  • Prevent talus shifting into a valgus position or to move anterolaterally or externally rotate
  • Prevent talus (med) shifting more than 2mm laterally, even if lat structures aren’t in place
  • Pos tibiotalar ligament restricts int rot of talus (deep fibers)
  • Sequential cutting of superficial ligament still results in ankle stability
  • Gross instability of ankle develops if deeper fibers of ligaments are cut (surgically)
  • Difficult to surgically repair
62
Q

What are the MED ankle considerations of the deltoid ligament?

A
  • Without deltoid ligament forces go through ankle and fracture fibula (Maisonneuve)
  • Isolated deltoid ligament injuries are rare (3-4%)
  • Usually with deltoid involved, other structures are injured as well
63
Q

What did a study on medial ankles find?

A

*47 ankles with chronic lateral ankle instability with no medial ankle pain, deltoid ligament injuries were observed in 72% of ankles
*In subgroup of patients with MRI evidence of lateral ligament injury, incidence of deltoid injury was 35%

signs: tenderness at MED gutter of ankle joint

64
Q

How to test medial ankle function?

A

-Movement into supination-external rotation
-Eversion-pronation
^ stress deltoid ligament
-Single heel raise is not indicative or diagnostic for deltoid ligament (test for tibialis posterior or lateral ligaments)

65
Q

What to further test for If medial pain is more upwards instead of the ‘gutter’, more likely that tibialis posterior is affected?

A

Think about the line around the pos side of the med ankle bone!!

-Posterior tibial tendonitis
*Unsteady gait
*Difficulty pointing toes inwards
*Failed heel raise

Test for ^:
-Squeeze tennis ball between medial ankles and raise up on toes
-From valgus heel position to varus
-Activation of tibialis posterior

^ excess bit of bone which can be a source of injury, kind of sticks to navicular and can be disrupted during injury  pain over navicular

66
Q

What is the mechanism of a high ankle sprain/syndesmotic sprain?

A

-Planted foot, pronating + externally rotating then blow at knee
-Rotational forces at mortise and tenon joint – major stress
- EXT ROT mechanisms
- longer recovery
- occurs in sports such as Hockey and Skin

67
Q

What happens to the talus in DF and PF?

A

DF: talus snug in joint between malleoli and against trochlear surface
PF: not snug

68
Q

Implications of high ankle sprain?

A

-Widening the ankle mortise by 1mm decreases the contact area of tibiotalar by 42%  instability and early arthritis (severe)
*Bracing may be a good idea because every time you walk, the tibio-fibular joint springs apart and could cause it to heal in a widened position, leading to instability after recovery

69
Q

How to test for a high ankle sprain?

A

External rotation test
* Place knee at 90 degrees with ankle at neutral
* Apply an external rotation force
Squeeze test
* Compress proximal tibia and fibula
* Positive test occurs at level of ankle joint
* Pain more proximally should alert suspicion of proximal fibula fracture
Crossover test
* Pressure applied to externally rotate ankle
 Patient pushes down on foot
* Pain will be felt with disruption of syndesmosis (not seen with LAS)
* Patient lead, will stop if pain is too bad

70
Q

How to treat high ankle sprains?

A

-Bracing
-Tight-rope (surgical correction)
*Rope holding pieces together
*Tighten rope until it can’t be tightened anymore
*Rope will break eventually but scar tissue should be able to hold it together
-Screw
*But will need to have surgery again to come out, not preferred because ankle should have some degree of mobility

71
Q

What is pain below the knee and above the ankle called? List out the characteristics for acute and chronic.

A

Compartment syndrome

Acute
* Direct trauma or fracture
* Compromise neurovascular bundles
 Muscles may not be receiving adequate perfusion
 Irreversible damage
* Not very common
* Signs:
 Pain and swelling in shin, numbness in foot and toes

Chronic
* Fascia thickening
 Continuous running can cause muscle hypertrophy but compartment doesn’t expand as well, trigger stimulus to fascia (muscle attaches to it)  can cause fascia to thicken
 Can be congenitally thicker
* Pressure can decrease after rest
* Exertional compartment syndrome more likely to happen on anterior side
 Back of leg is less contained than anterior

72
Q

How to test for compartment syndrome?

A

Important:
- Ask about patient history
* Friis’ example – creatine caused increase in muscle size due to water retention causing chronic compartment syndrome

Tests:
- Pressure testing

73
Q

What is the Tx for compartment syndrome?

A

Fasciotomy
*Pressure can build up again
*May do fasciectomy instead
Removes attachment site of anterior compartment muscles
Reduces recruitment ability of these muscles

74
Q

What is the Tx for compartment syndrome?

A

Fasciotomy
*Pressure can build up again
*May do fasciectomy instead
Removes attachment site of anterior compartment muscles
Reduces recruitment ability of these muscles

75
Q

What is ANT cortical stress fracture and the mechanism of it?

A

-Pain when tapping over the shin
-Do not heal properly and can take a very long time

Mechanism:
-Tibial Vara
-Overstriding when running
*Contact/lead foot in front of center of mass
-Others

76
Q

What is ANT cortical stress fracture and the mechanism of it?

A

-Pain when tapping over the shin
-Do not heal properly and can take a very long time

Mechanism:
-Tibial Vara
-Overstriding when running
*Contact/lead foot in front of center of mass
-Others

77
Q

What is the Tx or solution ot ANT cortical stress fractures?

A

-Change technique for running
-Center of mass over the foot
-Forefoot landing so less forces going through heel
*Reduce stride length, increase step rate
-Nail

78
Q

What are fibular stress fractures?

A

-Direct trauma to lateral calf
-Initial x-rays normal
-Torsional stress aggravates periosteal damage
*Particularly in jumping sports
-Serial radiology may be necessary
-Early rest for better long term results
-Presents/diagnosed as calf strain or peroneal tendonitis (associated with lateral ankle ligament injury)

79
Q

MRI image of fibular stress fracture. Which side is the fracture located?

A

L (always lateral side of calf)

If you don’t stop torsional forces going through fibular then it will progress to a full fracture.

SPMD3052 (20 decks)

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