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
|
|
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
|
|
Term
| How long does a Grade 2 ankle sprain take to heal? |
|
Definition
|
|
Term
| How long does a Grade 3 ankle sprain take to heal? |
|
Definition
|
|
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
|
|
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
|
|
Term
| Where is a Class A ankle fracture located? |
|
Definition
|
|
Term
| Where is a Class B ankle fracture located? |
|
Definition
|
|
Term
| Where is a Class C ankle fracture located? |
|
Definition
|
|
Term
| What is the most common class of ankle fracture? |
|
Definition
|
|
Term
| What is the treatment for a stable, undisplaced ankle fracture? |
|
Definition
|
|
Term
| What is the treatment for an unstable, reduced ankle fracture? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| Does an achilles tendon rupture have the option of not being treated? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the treatment for a stable 5th metatarsal base fracture that has been satisfactorally reduced? |
|
Definition
|
|
Term
| What is the treatment for an unstable, displaced 5th metatarsal base fracture? |
|
Definition
|
|
Term
| What metatarsal has the worst blood supply of all? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the treatment for a displaced Jones fracture (or in a high level athlete)? |
|
Definition
|
|
Term
| What is the treatment for a recurrent Jones fracture? |
|
Definition
| consider correcting hindfoot varus |
|
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