Term
| What are the 2 types of navicular fractures? |
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Definition
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Term
| What is the most common type of navicular fracture? |
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Definition
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Term
| What is the navicular avulsed by in an avulsion fracture? |
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Definition
| ligament or posterior tibial tendon |
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Term
| How does a navicular body fracture typically occur? |
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Definition
| with higher energy situations (MVA, falling from great height) |
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Term
| What type of navicular fracture more often requires ORIF? |
|
Definition
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Term
| What is the mechanism of injury for a navicular avulsion fracture? |
|
Definition
usually twisting injury
abduction common |
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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 |
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Term
| What is a Type 1 navicular body fracture? |
|
Definition
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Term
| What is a Type 2 navicular body fracture? |
|
Definition
| dorsolateral to plantarmedial |
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Term
| What motion causes a Type 2 navicular body fracture? |
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Definition
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Term
| What is a Type 3 navicular body fracture? |
|
Definition
| lateral or central comminution |
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Term
| What motion causes a Type 3 navicular body fracture? |
|
Definition
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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 |
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|
Term
| What things most commonly cause midfoot fractures? |
|
Definition
|
|
Term
| What things most commonly cause midfoot fractures? |
|
Definition
|
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Term
| What bones are involved in midfoot fractures? |
|
Definition
cuneiform
cuboid
or multiple bones |
|
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Term
| What are midfoot fractures often associated with? |
|
Definition
| joint dislocation and disruption of the strong plantar ligaments |
|
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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) |
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|
Term
| What is an important goal of treatment for a midfoot fracture? |
|
Definition
|
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Term
| What improves the prognosis for midfoot fractures? |
|
Definition
| early recognition and treatment with rigid ORIF and early motion |
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Term
| What is the typical history of a Lisfranc injury? |
|
Definition
twisting injury
fall
braking in MVA |
|
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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) |
|
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Term
| What type of x-rays should you try to get if at all possible if a lisfranc injury is suspected? |
|
Definition
|
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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 |
|
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Term
| Lisfranc is a _________ diagnosis. |
|
Definition
|
|
Term
| What is the prognosis for a lisfranc injury? |
|
Definition
| healing is prolonged (greater than ankle sprain) |
|
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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
|
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Term
| What are the most important points about a lisfranc injury? |
|
Definition
clinical diagnosis
takes ages to heal
ORIF if displaced |
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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
|
|
Term
| What phalanges are more functionally important? |
|
Definition
|
|
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
|
|
Term
| What are distal phalanx fractures often associated with? |
|
Definition
|
|
Term
| What does a distal phalanx fracture with a subungual hematoma require? |
|
Definition
|
|
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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