Flashcards in Ankle Deck (13)
What are 5 complications of ankle sprains?
- Anterior Tibiofibular ligament sprain (Malingerer’s Ankle AKA “High Ankle Sprain”)
- Talar Dome Fracture/ Osteochondral Fracture
- Avulsion fracture of the base of 5th metatarsal (“Jones Fracture”)
- Sinus Tarsi Syndrome
- Posterior Talar Process Fracture
Name 4 differentials of ankle sprains.
- Bifurcate Ligament Sprain
- Peroneal Tendon Dislocation
- Footballer’s Ankle (Soccer Ankle)
- Ski boot Neuropathy
Malingerer’s Ankle AKA “High Ankle Injury”
- Is an Anterior Tibiofibular Ligament Sprain.
- It has a longer healing time, due to the sprain not being recognized early enough.
- Excessive force can twist Talus in the Mortise Joint, causing a sprain
How does a patient with a High Ankle Sprain present?
- Pain on walking
- Pain on palpation
- Tib-Fib Squeeze Ortho may or may not be positive (Usually only complete tears are positive)
What is a Talar Dome Fracture (Osteochondral Fracture)?
- Secondary to ankle sprains
- Is often not recognized
- X-RAY: Medial Oblique (25* inversion from A-P)
Name the 4 Stages/ Types of (Talar Dome) Fracture and appropriate Tx plan.
- Compression only = Conservative care
- An edge of the fracture is lifted = Conservative care
- The fracture fragment is free, but approximated = Conservative care or surgery
- The fracture is fragment free and not approximated = surgery
What is Sinus Tarsi Syndrome?
- Late sequel of an ankle sprain
- Becomes evident weeks or months after injury
- Poor or no rehab indicating factor
- Pronation must be present
- Scar tissue formation can cause compression of the Talocalcaneal ligaments leading to pain and proprioceptive problems
How does a patient with Sinus Tarsi Syndrome present?
- Localized pain anterior to the lateral malleolus
- Patient has difficulty walking on uneven surfaces
- Ankle may have a feeling of giving way (semi-pathognomonic)
- Ortho Test: Talar Rock Test (Interosseous Talocalcaneal ligament; Sheer Talus & Calcaneus)
What is a “Jones Fracture,” the best X-Ray to take and Treatment?
- A “Jones Fracture” is an avulsion fracture of the 5th MT base.
- (MOI: In an ankle sprain, the peroneal tendon may pull significantly on the Peroneus Brevis insertion on the tuberosity of the 5th MT)
- Included in the Ottawa Rule
- X-ray: A-P
- Tx: Immobilzation w/ a cast or brace, 6-12 weeks; if fragment is displaced, surgery is indicated
How does a Posterior Talar Process Fracture occur and present?
- Excessive plantar flexion can fracture the Posterior Talar Process
- Posterior ankle pain
- Pain with forced plantarflexion of the foot or forced dorsiflexion of the great toe
- X-Ray/ CT: R/O Fx or accessory ossicle
What is a “Snowboarder’s Ankle Fracture” and how does it present?
- Fracture of lateral process of the Talus (a portion of the Posterior Talar Facet)
- MOI: Dorsiflexion and Inversion
- Current study +/- w/ External Rotation
- X-Ray not as sensitive, CT scan if highly suspected
How does a Peroneal Tendon Dislocation occur and how does it present?
- MOI: Forceful contraction of peroneals during dorsiflexion
- Common in young skier falling forward or following an ankle sprain
- Patient Presents: hears clicking when walking or running
- Tests: Resisted dorsiflexion and eversion; able to palpate/ inspect tendon anterior to lateral malleolus? Able to reproduce clicking?
What are the degrees in the Talar Tilt Test and their corresponding ligaments?
- 0* Plantar Flexion + Inversion = Calcaneofibular ligament
- 20* Plantar Flexion + Inversion = Talofibular ligament
- 0* Plantar Flexion + Eversion = Deltoid ligament (Posterior Tibiotalar & Tibiocalcaneal ligaments)
- 20* Plantar Flexion + Eversion = Deltoid ligament (Tibionavicular & Anterior Tibiotalar ligaments)