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Foot & Ankle Trauma 1
N/A
63
Medical
Professional
11/19/2011

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Cards

Term
What is typical mechanism of injury for an ankle sprain?
Definition
inversion and plantar flexion
Term
What would you find on PE of a patient with an ankle sprain?
Definition
tender anterolateral ankle
Term
What ligament is most commonly affected in an ankle sprain?
Definition
anterior talofibular ligament
Term
What characterizes a Grade 1 ankle sprain?
Definition
ligament is intact
pt. can still walk
Term
What characterizes a Grade 2 ankle sprain?
Definition
incomplete tear of the ligament
usually pt. can still walk
Term
What characterizes a Grade 3 ankle sprain?
Definition
complete tear
pt. cannot walk
Term
What are the Ottawa Rules used for?
Definition
determining if x-ray is needed in an ankle sprain
Term
When is an ankle x-ray series warranted with an ankle sprain?
Definition
only if there is pain near the malleoli and any of the following:
-inability to bear weight both immediately and in ED (4 steps)
-bone tenderness at posterior edge or tip of either malleolus
Term
What are all the possible sources of acute ankle pain?
Definition
high ankle sprain
ankle fracture
osteochondral injury
ankle sprain
sinus tarsi injury
subluxing peroneal tendons
Term
What is the treatment for the acute phase of an ankle sprain?
Definition
RICE
crutches PRN
Term
What is the treatment for the subacute phase of an ankle sprain?
Definition
PT (work on ROM, peroneal strengthening, proprioception)

prophylactic bracing??
Term
How long does a Grade 1 ankle sprain take to heal?
Definition
7-10 days
Term
How long does a Grade 2 ankle sprain take to heal?
Definition
10-20 days
Term
How long does a Grade 3 ankle sprain take to heal?
Definition
20-30+ days
Term
When is operative treatment for an ankle sprain used?
Definition
only for chronic instability with symptoms lasting >6 months
Term
What type of mechanism is usually the cause of an ankle fracture?
Definition
twisting
Term
What are the key components of the history in a patient with an ankle fracture?
Definition
immediate pain (lateral and/or medial)
difficulty weight-bearing
Term
What would you find on PE in a patient with an ankle fracture?
Definition
significant swelling and difficulty weight bearing

may have malleolar pain (posterior & anterior)
Term
What views do you want to get in an ankle series?
Definition
AP
mortise
lateral
Term
Where is a Class A ankle fracture located?
Definition
below syndesmosis
Term
Where is a Class B ankle fracture located?
Definition
at syndesmosis
Term
Where is a Class C ankle fracture located?
Definition
above syndesmosis
Term
What is the most common class of ankle fracture?
Definition
B (at sydnesmosis)
Term
What is the treatment for a stable, undisplaced ankle fracture?
Definition
splint
controlled ROM
Term
What is the treatment for an unstable, reduced ankle fracture?
Definition
cast for 6 weeks
Term
What is the treatment for an unstable, displaced ankle fracture?
Definition
ORIF vs closed reduction and cast
Term
What measure of displacement is an indication for surgery for an ankle fracture?
Definition
>2 mm
Term
Boots tend to work better than casts in ankle fractures. FYI
Definition
Term
If surgical treatment is needed, what would it be for a one malleolus ankle fracture?
Definition
fix fibula with screw/TB wire/plate
Term
If surgical treatment is needed, what would it be for a bimalleolar ankle fracture?
Definition
plate fibula, lag screw tibia
Term
If surgical treatment is needed, what would it be for a trimalleolar ankle fracture?
Definition
plate fibula, lag screw tibia
fix posterior if >20-25% articular surface
Term
What are key features of the history in a patient with an osteochondral talar injury?
Definition
may have catching or locking
ankle pain and swelling
acute injury vs. multiple "sprains"
Term
What would you find on PE in a patient with an osteochondral talar injury?
Definition
local or generalized ankle pain
ankle effusion
decreased ankle ROM
ankle instability
Term
How should an osteochonral talar injury be investigated?
Definition
x-rays (AP, lateral, mortise)

CT/MRI only if x-rays negative and management will be altered
Term
What is the treatment for an undisplaced osteochondral talar injury?
Definition
majority of lesions resolve with time
Term
What is the treatment for an osteochondral talar injury that has persistent symptoms lasting >4-6 months?
Definition
arthroscopic debridement and microfracture
Term
What is the treatment for a displaced osteochondral talar injury?
Definition
removal of loose bodies
Term
What is the prognosis for osteochondral taral injuries?
Definition
better if younger pt. (open physes)
acute lesions better than chronic
Term
What is the common statement made by a patient with an achilles tendon rupture?
Definition
"kicked/shot in the back of the leg"
Term
What would you find on PE in a patient with an achilles tendon rupture?
Definition
swelling
palpable gap
positive Thompson test
Term
What is the Thompson test used to diagnose?
Definition
achilles tendon rupture
Term
What is a positive Thompson test?
Definition
no passive foot plantar flexion when you squeeze the calf
Term
It is important to diagnose an achilles tendon rupture ______.
Definition
early
Term
Does an achilles tendon rupture have the option of not being treated?
Definition
NO!
Term
Are further investigations of an achilles tendon rupture required?
Definition
no, clinical diagnosis is sufficient
Term
What is non-operative treatment for an achilles tendon rupture?
Definition
gravity equinus 4-6 weeks, non-WB
WB cast 4-6 weeks, heel lift
min 12 weeks protection in boot/cast
no high-risk activites for 4-6 months
Term
Who is non-operative treatment for an achilles tendon rupture best for?
Definition
low demand, high risk patients
Term
What type of treatment for an achilles tendon rupture has a lower re-rupture rate and better strength outcomes?
Definition
operative treatment

protect in boot/cast 6-12 weeks
heel lift
Term
What is a "dancer's fracture?"
Definition
5th metatarsal base avulsion fracture
Term
What type of injury is a 5th metatarsal base fracture?
Definition
inversion
Term
What would you find on PE in a patient with a 5th metatarsal base fracture?
Definition
local tenderness
hindfoot varus
Term
How is a 5th metatarsal base fracture diagnosed?
Definition
x-rays
Term
What is the treatment for a stable 5th metatarsal base fracture that has been satisfactorally reduced?
Definition
cast (or CAM walker)
Term
What is the treatment for an unstable, displaced 5th metatarsal base fracture?
Definition
ORIF (1 or 2 lag screws)
Term
What metatarsal has the worst blood supply of all?
Definition
5th
Term
If a 5th metatarsal base fracture doesn't heal, what is is usually due to?
Definition
non-compliance, smoking, poor blood supply
Term
What is a Jones fracture?
Definition
metadiaphyseal 5th metatarsal fracture
Term
Where would a patient with a Jones fracture c/o pain?
Definition
lateral midfoot
Term
What would you find on PE in a patient with a Jones fracture?
Definition
tenderness of proximal 5th metatarsal
hindfoot varus
Term
What investigations need to be done in a patient suspected to have a Jones fracture?
Definition
x-rays (often diagnostic)
bone scan
Term
What is the treatment for an undisplaced Jones fracture?
Definition
cast for 6-8 weeks
Term
What is the treatment for a displaced Jones fracture (or in a high level athlete)?
Definition
ORIF--IM screw
Term
What is the treatment for a recurrent Jones fracture?
Definition
consider correcting hindfoot varus
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