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Foot & Ankle Trauma 2
N/A
47
Medical
Professional
11/19/2011

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Cards

Term
What are the 2 types of navicular fractures?
Definition
avulsion
body
Term
What is the most common type of navicular fracture?
Definition
avulsion
Term
What is the navicular avulsed by in an avulsion fracture?
Definition
ligament or posterior tibial tendon
Term
How does a navicular body fracture typically occur?
Definition
with higher energy situations (MVA, falling from great height)
Term
What type of navicular fracture more often requires ORIF?
Definition
body
Term
What is the mechanism of injury for a navicular avulsion fracture?
Definition
usually twisting injury
abduction common
Term
What is the treatment for a navicular avulsion fracture?
Definition
non-operative unless significant displacement (PT tendon pulled off)

if PT pulled off--ORIF with screws
Term
What is a Type 1 navicular body fracture?
Definition
transverse
Term
What is a Type 2 navicular body fracture?
Definition
dorsolateral to plantarmedial
Term
What motion causes a Type 2 navicular body fracture?
Definition
adduction
Term
What is a Type 3 navicular body fracture?
Definition
lateral or central comminution
Term
What motion causes a Type 3 navicular body fracture?
Definition
abduction
Term
What is the treatment for a navicular body fracture?
Definition
-anatomic reduction to preserve talonavicular joint
-stable fixation
-bone graft as necessary
-immobilize 8-12 weeks
-PT after healing complete
-talonavicular arthrodesis for persistent symptoms or marked comminution
Term
What things most commonly cause midfoot fractures?
Definition
high impact (MVA, fall)
Term
What things most commonly cause midfoot fractures?
Definition
high impact (MVA, fall)
Term
What bones are involved in midfoot fractures?
Definition
cuneiform
cuboid
or multiple bones
Term
What are midfoot fractures often associated with?
Definition
joint dislocation and disruption of the strong plantar ligaments
Term
What is the treatment for midfoot fractures?
Definition
-apply AO (ASIF) principles of anatomic reduction and rigid fixation
-medial and lateral column should be stable and balanced
-avoid operating through markedly swollen tissue (usually 7+ days for tissue swelling to settle)
Term
What is an important goal of treatment for a midfoot fracture?
Definition
restoring length
Term
What improves the prognosis for midfoot fractures?
Definition
early recognition and treatment with rigid ORIF and early motion
Term
What is the typical history of a Lisfranc injury?
Definition
twisting injury
fall
braking in MVA
Term
What would you find on PE in a patient with a Lisfrac injury?
Definition
very tender and swollen midfoot

pain with TMT movement (manipulation of MT heads)
Term
What type of x-rays should you try to get if at all possible if a lisfranc injury is suspected?
Definition
weight bearing
Term
What do you need to check in the x-ray with a lisfranc injury?
Definition
alignment

medial 2nd MT--middle cuneiform
medial 4th MT--cuboid
dorsal MT base--dorsal tarsal bone
Term
Lisfranc is a _________ diagnosis.
Definition
clinical
Term
What is the prognosis for a lisfranc injury?
Definition
healing is prolonged (greater than ankle sprain)
Term
What is the treatment for an undisplaced lisfranc injury?
Definition
cast 8-12 weeks
CAM walker
stiff-soled shoe
Term
What is the treatment for a displaced lisfranc injury?
Definition
ORIF
Term
What are the most important points about a lisfranc injury?
Definition
clinical diagnosis
takes ages to heal
ORIF if displaced
Term
What is the typical history of metatarsal fractures?
Definition
acute injury
direct blow/crush
Term
What would you find on PE in a patient with a metetarsal fracture?
Definition
swelling
localized pain (1 or more rays)
may have prominent metatarsal heads
Term
What are the goals of treatment for metatarsal fractures?
Definition
-stable, pain-free forefoot
-toes well-aligned
-metatarsal heads well-aligned
Term
What is the treatment for an isolated metatarsal fracture?
Definition
usually reduced (MT heads aligned)
cast-->CAM walker
Term
What is the treatment for multiple metatarsal fractures?
Definition
if reduced--cast
malreduced/unstable--ORIF
Term
What is the prognosis for metatarsal fractures?
Definition
generally heal well without long term problems
Term
What can cause problems with healing of metatarsal fractures?
Definition
-metatarsal heads too plantar or dorsal (altered forefoot weight distribution)
-multiple base fractures treated closed--behaves like lisfranc
Term
What phalanx is most commonly fractured?
Definition
proximal
Term
What phalanges are more functionally important?
Definition
hallux (big toe)
Term
What is the mechanism of injury for phalangeal fracutures and toe dislocations?
Definition
direct blow ("stubbing")
crushed by falling object
Term
What is the treatment for a phalangeal fracture if it is well-aligned?
Definition
conservative--buddy taping with or without hard-sole shoe
Term
What is the treatment for an unstable/comminuted hallux fracture?
Definition
pinning vs. mini plates
Term
What are distal phalanx fractures often associated with?
Definition
subungual hematoma
Term
What does a distal phalanx fracture with a subungual hematoma require?
Definition
sterile drainage
Term
What can you get with a distal phalanx fracture?
Definition
mallet toe (avulsion of EDL/EHL insertion)
Term
Where do toe dislocations occur?
Definition
interphalyneal (IP) joint
Term
How are pure toe dislocations treated?
Definition
closed reduction and taping
Term
How are toe fracture-dislocations with significant articular fragments treated?
Definition
often unstable
may need ORIF
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