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Podiatry Handbook notes > Ankle Pathology > Flashcards

Ankle Pathology Flashcards

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1
Q

Which Lateral Collateral ligaments are most commonly injured

A

1) ATFL- 95%
2) CFL
3) PTFL

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2
Q

MOI CFL and ATFL

A

CFL- DF+inversion. May also tear peroneal tendon sheath

ATFL- PF+inversion

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3
Q

Deltoid ligament: deep vs. superficial

A

Deep- anterior tibiotalar

Superficial: Tibionavicular, posterior tibiotalar, tibiocalcaneal

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4
Q

MOI of ankle joint capsule tear

A

due to hyper PF such as accidentally kicking the ground.

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5
Q

What is the classification system for ankle sprains

A

Diaz classification

Grade 1: ATFL injury
Grade 2: CFL injury
Grade 3: ATFL+CFL
Grade 4: PTFL

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6
Q

Function treatments for ankle sprain and timeline (5)

A

1) RICE/NSAIDS: immediately
2) Brace in Dorsiflexion: 1-3 weeks
3) ROM exercise: 3-6 weeks
4) Return to activity: 6-12 weeks
5) Prevent recurrence

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7
Q

Ankle fracture: what signs are you looking for on X-ray (3)

A
  • Tib-fib overlap
  • medial clear space
  • how the talus sits in the ankle mortise
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8
Q

Clinical exams that can be done to diagnose ankle fractures (5)

A
  • Anterior drawer test
  • talar tilt test
  • proximal squeeze test: least reliable
  • Distal compression : better test for syndesmosis injury
  • Eversion stress test: evert foot against the fibula. Better test for syndesmosis injury.
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9
Q

Exam that can be done in the OR for syndesmosis injury

A

Cotton test/hook test- best test for syndesmosis injury

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10
Q

Radiographic view to use for ankle injury

A

-Ankle mortise view

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11
Q

Components to look for on X-ray with ankle injury (5). The measurements and which is most reliable

A

-Medial clear space: >4mm abnormal
-Tib fib clear space: greater than or equal to 6mm abnormal. MOST RELIABLE
- Inversion stress view
Talocrural angle

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12
Q

X-ray findings to confer fibular length (2).

A

Shenton’s lines: line continues with spur of lateral malleolus with tibial plafond

Dime sign: assesses fibular length and talocrural angle

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13
Q

X-ray findings to check posterior malleolus (2)

A
  • external rotation on lateral view

- Double contour sign

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14
Q

Three classification systems for ankle fractures

A
  • Weber
  • Lauge-Hansen
  • Danis-Weber
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15
Q

Weber Classification (4)

A

A- fracture of the medial malleolus below the level of the ankle joint
B- Transverse fracture of the medial malleolus
C- Oblique fracture of the medial malleolus
D- vertical fracture of the medial malleolus

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16
Q

Danis Weber classification

A

A- fibular fracture below the level of the ankle joint
B- fibular fracture at the level of the ankle joint
C- fibular fracture above the level of the ankle joint

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17
Q

Lauge Hansen: 4 major groupings

A

Supination adduction (LH A)

Supination external rotation ( LH B)

Pronation Abduction (LHB)

Pronation external rotation (LH C)

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18
Q

Supination adduction

A

I: Avulsion fracture of the fibula
II: vertical fracture of the medial malleolus

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19
Q

Pronation abduction

A

I: Avulsion fracture of the tibia
II: PITFL and AITFL
III: Fracture of the fibula

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20
Q

Supination external rotation

A

I: AITFL injury
II: Fracture of the fibula (posterior spike) (Most common)
III: PITFL injury
IV: Medial malleolus fracture

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21
Q

Pronation External rotation

A

I: Medial malleolar fracture
II: AITFL
III: Fibular fracture (above the level of the ankle joint)
IV: PITFL

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22
Q

What is the problem with the lauge hansen classification system

A
  • Cadaveric study with the tibia stationary
  • Does not dictate treatment
  • 10% of fractures cannot be classified using this system
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23
Q

Tillaux-Chaput definition

A

avulsion fracture of the tibia from the AITFL

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24
Q

Wagstaffe definition

A

avulsion fracture of the fibula from the AITFL

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25
Volkmann definition
avulsion fracture of the tibia from the PITFL
26
Bosworth definition
avulsion fracture of the fibula from the PITFL
27
Maisonneuve fracture definition
fracture of the proximal fibula corresponding with PER III
28
Pott's fracture
bimalleolar fracture
29
Cotton fracture
trimalleolar fracture
30
Bimalleolar equivalent
rupture of the deltoid ligament instead of medial malleolar fracture. More unstable than actual fracture of the medial malleolus
31
Coonradd bugg trap
interposition of PTT prevents reduction of medial malleolar fragment
32
Butterfly fragment
in PAB, triangular wedge of cortical bone part of the comminuted fracture
33
Vassals phenomenon
reduction of the primary fracture allows the other fractures to self reduce
34
Greenstick fracture
only one cortex affected because the other side is too soft to break. Due to bending force
35
Torus fracture
Common pediatric fracture at the transitional zone between the metaphysis and diaphysis
36
Closed reduction: name of the technique and steps
Charnley technique 1) exaggerate 2) distraction 3) reduction
37
What to do in ankle fracture if the talus will not reduce
surgical emergency due to the neurovascular/skin compromise.
38
Surgical goal with ankle fractures
1) Maintain fibular length 2) Maintain ankle mortise 3) Ensure proper alignment of the talus 4) protect the syndesmosis
39
With ankle fractures what is the key to success concerning the lateral malleolus
quality of reduction
40
With ankle fractures with is the relationship between the talus and the fibula
fibula acts as a buttress, and the talus follows any fibular displacement
41
How to fixate oblique fracture at the lateral malleolus
with an interfrag screw
42
How to reduce fibular fracture at the midshaft or proximal fibula
no need to reduce just reduce the syndesmosis and those fracture will self reduce
43
For ORIF of the fibula what approaches can be used
Anterior approach Lateral approach posterior approach
44
things to look out for with anterior approach
avoid superficial peroneal N or AITFL
45
How to fixate with lateral approach
- interfrag screws in lag technique perpendicular to fracture line - 1/3 tubular plate used to neutralize torsional rotational force - At least 2 bicortical screws proximally and 2 unicortical screws distally
46
Posterior approach caution and how to fixate
caution with the sural nerve -use an anti-glide plate for best stability. Use unicortical screws distally to avoid entering the lateral gutter
47
With ankle fractures when is the only time to use only lag screw fixation on the fibula
long oblique and non-comminuted fractures only
48
How to fixate a Maisonneuve fracture
syndesmotic screw at distal fibula will reduce proximal fibular fracture
49
How to fixate the medial malleolus (4)
- tension band - 2x 4.0mm cancellous partially threaded screws across the medial malleolus - K-wire - antiglide plate
50
When to fixate the posterior malleolus
when more than 25% of the articular surface is effected
51
Techniques used to fixate the posterior malleolus
From posterior: better screw purchase. However requires more dissection From anterior: Technically easier however difficult to get all threads in without screw being too long or short
52
Syndesmosis injury what is the goal of treatment
reduction of fibular in fibular incisura of tibia
53
What technique is used in syndesmotic fixation
underdrill only insert screws parallel to joint as close to tibial plafond as possible. Direct the screws from Posterolateral fib to anteromedial tib.
54
What is the gold standard for syndesmotic injury
Syndesmotic screw
55
Syndesmotic screw: - Material - Size - number of cortices - When to remove - Side effects
- Material: no difference between stainless steel and titanium - Size: No difference between 3.5 and 4.5. 4.5 easier to remove but also causes greater irritation - number of cortices: 1 screw across 4 cortices will have higher chance of fracture. 2 screws across 3 cortices have better stability, better physiological movement - When to remove: at 3-4 months - Side effects: limitation of ankle ROM, broken screw, pain , screw removal, syndesmosis diastasis.
56
When is it not necessary to fixate syndesmosis?
When either the mosterior malleolus or medial malleolar osteoligamentous complex are fixated
57
Etiology of a pilon fracture
axial load of the talus being driven into the tibia
58
Foot position and location of tibial fragment(3)
Dorsiflexed foot= anterior tibial fragment Neutral foot = both anterior and posterior tibial fragment Plantarflexed foot= posterior tibial fragment
59
What other injuries should you look for in someone with a pilon fracture
calcaneus, tibial plateau, pelvis , acetabulum, and spinal damage
60
What are the classification systems for pilon fractures
Ruedi and Allgower. AO classification
61
How to treat a pilon fracture (4)
- fibular reduction - tibial plafond reduction - fill any voids with cancellous bone - stabilize medial tibia with a buttress plate
62
FDA approved methods for TAR (5)
- Agility - STAR - INBONE - Salto-Talaris - Zimmer TM ankle
63
What is the gold standard treatment for ankle arthritis
ankle fusion
64
Ste ps to the Blair procedure and what is is used for
Remove talar body, put foot in 10-14 degrees equinus and tibial graft placed into talar neck. -Used for talar body AVN and severely comminuted talar body fracture.
65
Etiology of OCD
Compaction, shearing, avulsion
66
Extent of damage of OCD based on
- Cartilage: shallow depth | - Cartilage+ Subchondral bone: deep depth
67
Classification system for OCD
``` Berndt and Harty 1-Compression injury 2- Partial detachment of cartilage 3- complete detachment of cartilage 4- displacement of fragment ```
68
DIAL - shape - stability - pain - outcome
Shape: shallow wafer shape Stability: less stable more likely to be displaced Pain: more pain outcome: easier to treat
69
PIMP - Shape - Stability - Pain - outcome
- shape: deep cup shape - more stabile - less pain - more difficult to treat
70
Ports used in arthroscopic correction of OCD (3)
- anteromedial: medial to TAT, anterior to medial malleolus - Anterolateral- lateral to peroneus tertius, medial to lateral malleolus - Anterocentral- between EHL and EDL tendon
71
How to treat small OCD lesions
through excision and curettage: subchondral drilling and microfracture
72
How to treat larger lesions (4)
- Mosaicplasty aka OATS (osteochondral Autograft Transplant system - Denovo Juvenile Cartilage Graft - Talar en-block - Subchondroplasty
73
Surgical treatments for ankle instability (4)
- Brostrom Gould: Brostrom ATFL repair through imbrication. Gould inferior extensor retinaculum sutured to perioseum. - Evans: PB routed through fibula Watson-Jones: rerout PB tendon through fibula with ATFL repair Chrisman Snook reconstruct ATFL and CFL using split PB
74
Peroneal subluxation/displacement: MOI
skiing
75
classification system for peroneal subluxation
Eckert and Davis Classification 1) Retinaculum separates from fibrocartilagenous ridge (most common) 2) Fibrocartilagenous detaches from fibula 3) Avulsion fracture of fibula (least common)
76
Surgical options for peroneal subluxation (3)
- Peroneal stop procedure (PB to PL tenodesis) - Tendon debridement - Peroneal tubularization
77
Etiology of os peroneum syndrome (3)
- os peroneum located within PL tendon - Fracture or diastasis of os peroneum - Tear or rupture of the peroneus longus tendon
78
Surgical treatment for os peroneum syndrome(3)
excision of os peroneum - tendon repair - PB to PL tenodesis

Podiatry Handbook notes (10 decks)

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