Y5 - Ankle & foot: fracture (ankle, metatarsal stress, Lisfranc) Flashcards
definition
fractures of either medial, lateral, or posterior malleolus
epi
most common in white women and least common in non-white men
what is the most common fracture pattern
isolated fibular fracture (55%)`
what is the average age of ankle fractures
40yrs
what is the most common mechanism of fracture
fall
what is the most common ankle fracture (not pattern)
lateral malleolus (705)
aetiology
most commonly low-energy fracture
inversion injury to ankle
sporting injury
what sort of force typically causes a malleolar fracture
rotatory force
what classification system is used to group the injury based on the mechanism
Lauge-Hansen classification
presenting symptoms
recent trauma
ankle pain and swelling
inability to weight-bear
malleolus swollen and tender
what does tenting of the skin over the medial malleolus indicate
dislocation
what is the 1st line investigation
plain x-ray
what view x-ray should be obtained
a mortise view (15 internal rotation of the ankle)
non-operative management
casting for 6 weeks
analgesics
management of open fractures
irrigation and debridement
surgery
antibiotics
what bacteria should be considered with open fractures
tetanus
what is the 1st line management for an open fracture
emergency surgery
what is the 1st line management for a closed fracture with dislocation
closed reduction and splint
what is the 1st line management for an isolated malleolar fracture
short-leg cast
what is the 1st line management for a bimalleolar/trimalleolar fracture
short-leg cast or internal fixation
who is ankle fractures common in
athletes (basketball players)
complications
fracture non-union
hardware irritation
what is fracture non-union
permanent failure of healing following a broken bone
when may a fracture non-union occur
if the fracture moves too much
poor blood supply
infection
prognosis
many will complain of stiffness, pain, swelling
what is a metatarsal stress fracture
small fracture or severe bruising in the bone due to overuse and repetitive activity
who is metatarsal stress fractures common in
runners and athletes
risk factor for metatarsal stress fracture
osteoporosis
change in exercise type or intensity
where do stress fractures most commonly occur
second and third metatarsals (longer and thinner than the first)
why are females more prone to stress fractures than men
the "female athlete triad" -the extremes of dieting or exercise lead to: 1 eating disorders 2 menstrual dysfunction 3 premature osteoporosis
symptoms of stress fracture
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
investigations
x-ray
management
RICE
modify activities
protective footwear
when might a stress fracture be treated with a cast
a 5th metatarsal bone stress fracture (or talus bone)
what is the lisfranc joint
junction between forefoot and midfoot
what is lisfrancs ligament
a ligament which originates from the medial cuneiform and attaches to the second metatarsal
how is lisfrancs joint commonly injured
severe twisting of forefoot and midfoot
management of lisfrancs injury
immobilisation for 6-8wks
followed by crutches
