ankle injuries / salter-harris

Question 1

ottawa ankle rules

Answer 1

x-ray only if pain in malleolar zone AND:
1. inability to weight bear for 4 steps
2. tenderness over distal tibia
3. bone tenderness over distal fibula

Question 2

Weber classification for ankle fracture

Answer 2

related to level of fibular fracture:
A = below syndesmosis
B = involve syndesmosis
C = above sydesmosis

Question 3

maisonneuve fracture

Answer 3

spiral fibular fracture that leads to disruption of syndesmosis with widening of the ankle joint

Question 4

management of ankle fractures

Answer 4

all should be promptly reduced to remove pressure on the overlying skin + subsequent necrosis

young with high velocity/unstable = surgical repair, using compression plate

elderly (even with unstable) = conservative mx - thin bones dont hold metalwork well

Question 5

greenstick fracture

Answer 5

unilateral cortical breach only

Question 6

buckle (“torus”) fracture

Answer 6

incomplete cortical disruption resulting in periosteal haematoma only

Question 7

fracture affecting growth plate classification

Answer 7

Salter-Harris

Question 8

salter-harris system

Answer 8

I = S = straight across physis

II = A = Above (physis+metaphysis)
III = L = beLow (physis+epiphysis)

IV = T = through (Vertically - phy+meta+epi)

V = R = cRush (may look similar to 1)

Question 9

which salter harris fractures require surgery

Answer 9

III(L), IV(T), V(R)

V = assoc with disruption to growth

Question 10

what causes osteogenesis imperfecta

Answer 10

failure of maturatiion of collagen in all connective tissues

• tranlucent bones, multiple fractures (esp long bones)
• wormian bones (irregular patches of ossification)
• trefoil pelvis

Question 11

osteopetrosis

Answer 11

• bones become harder + more dense
• autosomal recessive
• commonest in young adults

marble bone = lack of differentiation between cortex + medulla

Question 12

commonest sites of metatarsal fracture

Answer 12

commonest = 5th - proximal avulsion, assoc with ankle sprain, follow inversion injuries

stress fractures = 2nd !! runners etc

Question 13

3 ligaments the syndersmosis of tibia and fibula

Answer 13

anterior inferior tibiofibular ligament

posterior inferior tibiofibular ligament

interosseous ligament
deltoid ligament?
interosseous membrane

Question 14

which ankle ligament is most commonly injured in low ankle sprains

Answer 14

anterior talofibular ligament (ATFL)

• inversion most common mechanism

Question 15

lateral knee pain in runners

Answer 15

iliotibial band syndrome

• tenderness 2-3cm above lateral joint line