Flashcards in 04 Ankle 1 Deck (59):
What are you looking for on an ankle radiograph?
diastasis of the ankle mortis
What is diastasis indicative of and why is it so important to not miss?
- indicative of syndesmotic injury
- typically goes on to DJD in the talus
- surgery would be done immediately
What is the radiograph view used for the ankle?
- talar tilt radiograph
- angle that's created with a stress radiograph
If the symptoms are on the physis, you can't see anything on the radiograph, but the patient is symptomatic, what would you think it is?
Salter-Harris type 1 fx
types of casts
- short leg cast
- leg cylinder cast
- long leg cast
rule of casting and bracing
always immobilize the joint above and below
Which cast is not used often and why?
- cylinder cast
- doesn't immobilize prox and dist joints
For surgeries on fractures, what dictates the type of surgery that's done?
fracture pattern dictates
What are the common causes for shin pain?
- anterior lateral shin splints
- posterior shin splints
- medial tibial stress syndrome
- stress fx
anterior lateral shin splints
usually an overuse of extensor compartment
posterior shin splints
overuse of flexors (?)
What would lead you to think the shin pain was myositis?
- if it's in the muscle, it's myositis
What would lead you to think the shin pain was tendonitis/osis?
more symptoms on the tendon area than the bone
- propagation injury
- will progress to medial tibial stress syndrome
What is medial tibial stress syndrome a precursor to?
medial tibial stress syndrome
- some microfractures of the tibia
- extremely painful
MTSS may involve one of these syndromes
- overuse syndrome
- can progress to irreversible, external compartment syndrome
How many grades of injury for MTSS?
Where can stress fractures occur?
anywhere in the lower extremity
Where are stress fx more commonly seen in the LE?
- 4th metatarsal
- then tibia
- then femoral neck
often seen in runners and military recruits
What is the most sensitive but not specific imaging technique to identify a stress fx?
- bone scan, not done as much now
tibial stress fx
- bigger deal than fibular because it bears 95% of the weight
- with a fx, it forms a callus
6 P's of acute compartment syndrome
- pain: out of proportion to clinical exam
- pain: with passive stretch
6 P's of compartment syndrome: most significant early sign
pain out of proportion to clinical exam
6 P's of compartment syndrome: pressure
(early consistent finding)
6 P's of compartment syndrome: paralysis
6 P's of compartment syndrome: pulses
present (pale toes)
6 P's of compartment syndrome: paresthesia
sensory deficit (usually late)
first steps in dx for acute compartment syndrome
1. OBTAIN URGENT SURGICAL CONSULT
2. maintain normal BP
3. remove anything that can impede circulation
4. maintain limb at heart level
surgery for acute compartment syndrome
open procedure, flayed open
What may happen if you miss acute compartment syndrome?
chronic compartment syndrome
- increased compartmental pressure
- 4 compartments of the lower leg, fascial tissue doesn't expand
What are the 4 compartments of the lower leg
- deep posterior
- superficial posterior
most to least common sites of chronic compartment syndrome
2. deep posterior
4. superficial posterior
Why might exercise exacerbate chronic compartment syndrome?
- causes perfusion of blood
- not much room for expansion
symptoms for chronic compartment syndrome
- leg is swollen, tight, pale, and shiny
- foot drop
- can't actively dorsiflex
What wil you feel with chronic compartment syndrome?
hard, "woody" feeling with no historesis response
What is happening in to the NV tissue in chronic compartment syndrome?
swollen muscle compresses the nerves and vessels in the leg
What is done to assess for chronic compartment syndrome?
put wick catheter into the area to gauge the pressure
- resting pressure
- exercise pressure
- recovery phase
chronic compartment syndrome: resting pressure
- each compartment has its own normative data
- will be elevated
chronic compartment syndrome: exercise pressure
- elevated and stays elevated for a prolonged period afterward
- much higher than normative data
chronic compartment syndrome: recovery phase
prolonged compared to normal individuals
procedure to fix chronic compartment syndrome
- fasciotomy is done to decompress
- done underneath the skin, so you can't really see it
Who typically gets chronic compartment syndrome and how does it manifest?
- c/o shin pain
- have been to several physicians with multiple dx and treatments
- can tell exactly when the pain starts (specific time or distance)
If a patient presents with chronic compartment syndrome, are they a PT patient?
NO NO NO
Why must you always palpate posteriorly for the Ottawa ankle rules?
85-90% of the time, the anterior talofibular ligament is involved in ankle sprains
What is pain over the distal tib-fib ligament indicative of?
What is the most common type of sprain?
plantarflexion inversion sprain
What should you also consider with a plantarflexion inversion sprain?
also be concerned about a Pott's fx
What does an eversion sprain involve?
high ankle sprain:
What is happening with a diastasis injury?
- distal anterior tib/fib ligament is injured
- membrane between the tib/fib and distal part of interosseous injury
Why is a diastasis injury serious?
- stability of the ankle
- subsequent OA changes
A high ankle sprain may also involve this type of force
ER force in a high ankle sprain: what happens to the talus and fibula
talus forces the fibula out
- may get a Pott's fx
- tear the distal anterior tib/fib ligament
How can ecchymosis location tell you if it's a high ankle sprain?
- anterior lateral part of the ankle
- predictive of what kind of injury it is in the ankle
treatment for high ankle sprain
almost always ORIF