Y5 - Ankle & foot: fracture (ankle, metatarsal stress, Lisfranc)

Question 1

definition

Answer 1

fractures of either medial, lateral, or posterior malleolus

Question 2

epi

Answer 2

most common in white women and least common in non-white men

Question 3

what is the most common fracture pattern

Answer 3

isolated fibular fracture (55%)`

Question 4

what is the average age of ankle fractures

Answer 4

40yrs

Question 5

what is the most common mechanism of fracture

Answer 5

fall

Question 6

what is the most common ankle fracture (not pattern)

Answer 6

lateral malleolus (705)

Question 7

aetiology

Answer 7

most commonly low-energy fracture
inversion injury to ankle
sporting injury

Question 8

what sort of force typically causes a malleolar fracture

Answer 8

rotatory force

Question 9

what classification system is used to group the injury based on the mechanism

Answer 9

Lauge-Hansen classification

Question 10

presenting symptoms

Answer 10

recent trauma
ankle pain and swelling
inability to weight-bear
malleolus swollen and tender

Question 11

what does tenting of the skin over the medial malleolus indicate

Answer 11

dislocation

Question 12

what is the 1st line investigation

Answer 12

plain x-ray

Question 13

what view x-ray should be obtained

Answer 13

a mortise view (15 internal rotation of the ankle)

Question 14

non-operative management

Answer 14

casting for 6 weeks

analgesics

Question 15

management of open fractures

Answer 15

irrigation and debridement
surgery
antibiotics

Question 16

what bacteria should be considered with open fractures

Answer 16

tetanus

Question 17

what is the 1st line management for an open fracture

Answer 17

emergency surgery

Question 18

what is the 1st line management for a closed fracture with dislocation

Answer 18

closed reduction and splint

Question 19

what is the 1st line management for an isolated malleolar fracture

Answer 19

short-leg cast

Question 20

what is the 1st line management for a bimalleolar/trimalleolar fracture

Answer 20

short-leg cast or internal fixation

Question 21

who is ankle fractures common in

Answer 21

athletes (basketball players)

Question 22

complications

Answer 22

fracture non-union

hardware irritation

Question 23

what is fracture non-union

Answer 23

permanent failure of healing following a broken bone

Question 24

when may a fracture non-union occur

Answer 24

if the fracture moves too much
poor blood supply
infection

Question 25

prognosis

Answer 25

many will complain of stiffness, pain, swelling

Question 26

what is a metatarsal stress fracture

Answer 26

small fracture or severe bruising in the bone due to overuse and repetitive activity

Question 27

who is metatarsal stress fractures common in

Answer 27

runners and athletes

Question 28

risk factor for metatarsal stress fracture

Answer 28

osteoporosis

change in exercise type or intensity

Question 29

where do stress fractures most commonly occur

Answer 29

second and third metatarsals (longer and thinner than the first)

Question 30

why are females more prone to stress fractures than men

Answer 30

the "female athlete triad"
-the extremes of dieting or exercise lead to:
1 eating disorders
2 menstrual dysfunction
3 premature osteoporosis

Question 31

symptoms of stress fracture

Answer 31

pain (intensifies during normal activities, diminishes during rest)
swelling on top of foot or outside of ankle
tenderness to touch at the site of the fracture

Question 32

investigations

Answer 32

x-ray

Question 33

management

Answer 33

RICE
modify activities
protective footwear

Question 34

when might a stress fracture be treated with a cast

Answer 34

a 5th metatarsal bone stress fracture (or talus bone)

Question 35

what is the lisfranc joint

Answer 35

junction between forefoot and midfoot

Question 36

what is lisfrancs ligament

Answer 36

a ligament which originates from the medial cuneiform and attaches to the second metatarsal

Question 37

how is lisfrancs joint commonly injured

Answer 37

severe twisting of forefoot and midfoot

Question 38

management of lisfrancs injury

Answer 38

immobilisation for 6-8wks

followed by crutches