A N K L E

Question 1

what is an ankle sprain, lx and management

Answer 1

Ligamentous injury
MOI – inversion of the foot
High – syndesmosis involvement
Low – ATFL and CFL
Investigations – XR (rule out #)
Management – conservative (‘RICE’)

Question 2

frequently sprained ligaments in ankle

Answer 2

Anterior talofibular ligament

Calcaneofibular ligament

Question 3

how do ankle fractures present

Answer 3

Ankle pain
Swelling
Obvious deformity
NV compromise

Question 4

classifications of ankle fractures

Answer 4

weber’s

Question 5

describe weber’s classification of ankle fractures

Answer 5

Classifies ankle fractures according to the location of a lateral malleolar fracture relative to the syndesmosis

C – above, requires operative management

B – at the level of the syndesmosis, management will depend on degree of displacement and other injuries

A – below, conservative management is the mainstay

Question 6

what are ottawa rules of ankle fractures

Answer 6

Medial malleolus tenderness

Lateral malleolus tenderness

Inability to WB immediately after injury or after 4 steps in ED

Question 7

lx in ankle fracture

Answer 7

Ankle XR – AP, mortise, lateral

CT ankle for complex fractures (aids operative planning)

Question 8

management of ankle fractures

Answer 8

1. A to E and ATLS principles, particularly in polytrauma where ankle fracture may be a distracting injury
2. Urgent reduction
3. Document post NV assessment
4. Conservative management (immobilisation in ankle boot) if Weber A
5. Operative management in Weber C (sometimes B if talar shift), displaced bi/trimalleolar # and open # – ORIF

Question 9

complications of ankle fractures

Answer 9

Arthritis - reduced with appropriate early reduction

Wound infection

Exposed metalwork

DVT/PE

Neurovascular injury

Non-union

Question 10

describe pathophysiology of achilles tendonitis/ rupture

Answer 10

Inflammation of the calcaneal tendon that may lead to rupture
More common in those who engage in athletic activities (running, jumping)
Typically younger, active males
Spectrum of microtears to full thickness tear
If tendonitis, progressive pain and stiffness
If tear, presentation will be sudden onset pain and swelling

Question 11

investigations of achilles tendonitis/rupture

Answer 11

Mainly clinical (Simmond’s test)
USS if diagnosis uncertain

Question 12

management of achilles tendonitis/ rupture

Answer 12

Conservative if partial/uncomplicated tear

Surgical if complete tear, failure of expectant management or if professional athlete

Question 13

what is a hallux valgus

Answer 13

Most common foot deformity
Appearance of a ‘bunion’
Lateral deviation/subluxation of the first MTP joint
More common in F>M, those with flat feet and hypermobility disorders
Can result in gait abnormalities and AVN if severe