Ankle Trauma

Question 1

What are the key ligaments in the ankle

-which are the most commonly damaged

Answer 1

Lateral

• post/ant talofibular - ANKLE SPRAINS
• calcaneofibular - ANKLE SPRAINS
• post/ant tibiofibular

Medial
-medial

ATFL most common area of injury
-inversion injury

Question 2

Ankle sprains

• pathophysiology
• presentation
• investigations
• management

Answer 2

Stretching, partial/complete tear of ligament often from inversion injury

• pain, swelling, tenderness, bruising
• weight bearing may be possible

Xray

PRICE
-if symptoms don’t settle/joint instability => surgery may be needed

Question 3

Ottawa ankle rules

-when would you Xray?

Answer 3

Can’t weight bear immediately and in ED
Pain and bony tenderness in
-distal malleoli
-base of 5th metatarsal or navicular

Question 4

Ankle fractures

-Xray findings

Answer 4

AP ankle

• Decreased tibiofibilar overlap U10mm => syndesmotic separation?
• Increased tibiofibular clear space 5mm+ => syndesmotic separation
• Talar tilt - talus and tibia not paralel, 2mm+ gap not normal

Question 5

Weber Classification - fibula fractures
Type A, B, C Ankle fracture
Other displaced ankle fractures
-management

Answer 5

A - below syndesmosis
-normally stable, only need POP cast
B- at syndesmosis
-unstable, surgery needed
C- above syndesmosis
-unstable, surgery needed

Other-if circulation in danger

• entonox, IV morphine before xray
• early ortho referral

Question 6

Tendoachilles tear

• presentation
• other causes other than trauma
• investigations
• management

Answer 6

Patient reports a pop
Weakness, difficulty walking
Heel pain

RA, SLE, renal failure, highPTH, highlipoproteinemia, gout

Simmond’s test - squeeze calf => no passive plantarflexion

Refer to ortho for operative repair

Question 7

GENERAL ASSESSMENT FOR LIMB INJURIES

Answer 7

Mechanism of injury
Xray joint, above and below
Assess neurovasculature
Analgesia
Fluids especially in femoral fractures
WATCH OUT FOR COMPARTMENT SYNDROME
Refer to ortho if in doubt