7. Acute Ankle Sprains

Question 1

ottowa ankle rules: function

Answer 1

to determine if xrays are needed

Question 2

AMA standard classification: function

Answer 2

for ankle sprains; used across all specialties;

- grade 1, 2, and 3

Question 3

O’donaghue classification: function

Answer 3

*MC used: for ankle sprains;

type 1-type III

Question 4

mann & coughlin classification: function

Answer 4

related to treatment; so it’s more helpful (ankle sprains)

• type I (stable ankle),
• type II (unstable ankle), subdivided into group 1 and group 2 (group 2 type A, B, C)

Question 5

talar tilt test: function and abnormal

Answer 5

for CFL injury;

positive if >10 degrees, or >5 degrees versus uninjured side

Question 6

anterior drawer test: function and abnormal

Answer 6

for ATFL injury;

positive if > 2 cm

Question 7

on AP view, what injury is identified by an INCREASE IN MEDIAL CLEAR SPACE in medial gutter

Answer 7

suggests a deltoid rupture

Question 8

deltoid injuries: epidemiology

Answer 8

significantly less frequent (<10% of all injuries); more common in athletic setting; concurrent with acute ankle fractures

Question 9

what should you do if you see an INCREASE IN MEDIAL CLEAR SPACE, but no ankle fracture, what should you do?

Answer 9

get a high tib-fib xray to rule out a fibular fracture

Question 10

are surgical repairs appropriate after acute ligament rupture in the ankle?

Answer 10

NO, there is NO major place for surgical repair after acute ligament ruptures

Question 11

what percentage of all acute ankle injuries are recurrences?

Answer 11

75% of all ankle injuries

Question 12

how can you prevent recurrence of ankle injuries?

Answer 12

coordination training (balance boards), external support (ankle taping, functional splinting, air case); rehab such as active ROM, peroneal strengthening, early WB, excellent or good functional results

Question 13

what percentage of acute ankle injury cases develop secondary symptoms of chronic instability or pain?

Answer 13

10-30% of cases develop secondary symptoms of chronic instability or pain

Question 14

what are high ankle sprains (other name) and what are they associated with?

Answer 14

aka SYNDESMOSIS injuries; associated w/ fractures (pronation, external rotation)

Question 15

high ankle sprain injury mechanism

Answer 15

external rotation and eversion

Question 16

what are the anatomical components of the high ankle syndesmosis?

Answer 16

four total:

AITFL (ant-inf tibiofibular ligament), PITFL, transverse interosseous ligament, interosseous ligament

Question 17

list the ligaments of the syndesmosis of the tib-fib, and their respective percentage contribution:

Answer 17

• AITFL: 35%
• PITFL: 33%
• Interosseous ligament: 22%
• superficial fibers: 9%

Question 18

what clinical exam for high ankle sprains?

Answer 18

squeeze test, external rotation test, hook test (for lateral translation of the heel), heel rise (showing dec strength, pain w/ push off)

Question 19

hook test: function

Answer 19

lateral translation of heel; intra-operative test; get a bone hook and hook it around the fibula and pull –> check it after you fix it (if no hook, then you can do dorsiflexion and external rotation)

Question 20

what are you looking on xray when diagnosing a syndesmosis injury (high ankle sprain)?

Answer 20

tib-fib overlap, tib-fib clear space, medial clear space

Question 21

high ankle sprain: results with heel rise diagnostic test

Answer 21

shows decreased strength and pain with push off

Question 22

if you are treated non-operatively AND CONCERNED; then what?

Answer 22

get an MRI

Question 23

tx for acute ankle sprain

Answer 23

most ligamentous injuries are treated conservatively –> CAM boot until pain-free, transition to brace, continue bracing/taping for athletic activities

Question 24

tx for fractures

Answer 24

most fractures treated surgically –> screws, tight ropes, static fixation (dynamic joint)