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Foot-Ankle-Tibia Flashcards

(63 cards)

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1
Q

Tibial Shaft Fracture

A
  • Most common Long bone fracture
  • Low energy mech: torsional, fibula fractures at a different level
  • High energy: trauma, direct force, wedge shape, fibula fractures at same level
  • associated with soft-tissue injury, compartment syndrome bone loss
  • deformity, pain, inability to bear weight
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2
Q

Radiographs: tibial fracture

A

AP and lateral of entire bone and knee/ankle

CT of the joint if intra-articular extension is noted

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3
Q

Non-Operative Treatment of tibial fracture

A

For low energy; needs appropriate alignment

<5* angulation,
<1 cm shortening,
<10* rotational malalignment,
more than 50% cortical apposition

Long leg cast for 6-8 weeks

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4
Q

External Fixation of Tibial Fracture

A

Damage control ortho

open fractures

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5
Q

Intramedullary nailing (T)

A

unacceptable alignment

soft tissue injury

segmental or comminuted fractures

multi-trauma

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6
Q

Open Reduction Internal Ficxation (ORIF) (Tibia)

A

higher risk of non-union and infection

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7
Q

Acute compartment syndrome (CS)

A

Osseofascial pressures rise to reduce perfusion leading to muscle necrosis (surgical emergency

2-15% of tibial fractures

Muscle perfusion pressure (^P) is the diff b/n diastolic press and compartment press (<30 mmHg is considered critical)

Maintain high index of suspicion and look for signs

Emergent fasciotomy

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8
Q

Tibial Plafond (pilon) Fractures

A

intrarticular disc distal tibial fracture

high energy axial loading mechanism (MVC, fall)

Articular impaction, metaphyseal communication, extensive soft tissue damage

presents with pain, inability to bear weight, deformity

inspect soft tissue for injury, signs of CS

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9
Q

Non-Op management of Pilon Fracture

A

Stable fractures can receive a long leg cast, significant risk of malreduction, skin problems

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10
Q

Temporizing Spanning external fixation of Pilon Fractures

A

allows skin access

obtain CT of joint post op

leave in place 10-14 days

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11
Q

ORIF of Pilon Fracture

A

Definitive fixation with peri-articular plates and screws

infection (5-15%), wound slough (10%)

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12
Q

Ankle Fracture

A

15% of all ankle injury

Usually inversion

radiographs not always indicated
(ottawa ankle rules, CT/MRI not indicated)

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13
Q

Sonographic Ottowa Foot and Ankle Rules (SOFAR)

A

increases specificity to 100% versus Xray

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14
Q

Radiographs of ankle fracture

A

AP, Lat, Obl

full length of Tib/Fib inlcuded

External rotation stress if syndesmotic injury expected

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15
Q

Syndesmotic Injury and Evaluation

A

Ankle Joint (sprain) medial clear space

Tib/Fib clear space is normally <5mm

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16
Q

Non-op ankle fracture treatment

A

for isolated, non-displaced fracture

lateral malleolar fracture <3mm displaced

non-surgical candidate

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17
Q

ORIF of ankle

A

displaced fracture

bimalleolar fracture

open fracture

prolonged recovery- up to 2 yrs

Time to driving needs to be 6 weeks FOLLOWING weight bearing

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18
Q

Talar neck fracture

A

High energy mech with forced dorsiflexion and axial load

Vascular supply- post tib artery, ant tib artery, peroneal artery

fractures result in risk of avascular necrosis

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19
Q

Talar neck radiography

A

Ap/Lat/ Canale view

CT for displacement

Hawkins classification

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20
Q

Hawkins Classification

A

insert picuter

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21
Q

Treatment of Talar neck Fracture

A

Emergent reduction in ER

Non-op for non-displaced (short cast for 8-12 weeks (non weight bearing for 6 wks)

ORIF for any displaced fractures

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22
Q

Hawkins Sign

A

signals avascular necrosis

subchondral lucency at 6 weeks is indication of intact vasculature

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23
Q

Calcaneal Fracture

A

High energy axial load- MVC or high fall

high rate of complications

Intraarticular fractures

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24
Q

Radiography of Calcaneal fracture

A

Bohler angle, 20-40*

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25
Treatment of calcaneal Fracture
ORIF for displaced wait 10-14 for swelling resolution
26
Metatarsal Fracture
Direct crush injury or indirect twisting injury stress fractures (look for a metabolic disorder, 2nd metatarsal base stress fracture in ballet dancers with amenorrhea) presents with pain, inability to bear weight
27
Treatment of Metatarsal Fracture
Stiff soled shoe and weight bearing as tolerated Surgery- displaced 1st fracture and central metas with severe displacement
28
Jones Fracture
5th metatarsal common in athletes, laborers, military recruits Mech: inversion injury w predromal stress injury classified by vascular supply
29
Jones Fracture Classification
add
30
Treatment of Jones Fracture
add
31
Complications of Jones Fracture
non-union in zone 2- 30% | refracture in Zone 2- 33%
32
Chronic exertional compartment syndrome (CECS)
reversible ischemia to muscles in a fascial compartment Occurs in runner (mainly anterior compartment) Presents with burning pain in legs following activity that resolves with rest
33
Evaluation of CECS
imaging is usually normal, but used to rule out others compartment pressure testing with exercise
34
What pressures are measured in CECS
- pre-exercise (resting) - Immediate (post exercise) - 5 min post exercise
35
Diagnostic criteria for CECS
Resting >15 mmHg Immediate >30mmHg 5 min post >20 mmHg
36
Treatment of CECS
rest, NSAIDS compartment release if not responsive to initial management after 3 months
37
Tibial stress syndrome
Overuse injury characterized by pain at distal medial aspect of tibia with activity Diagnosis in 60% of leg pain syndromes (other causes: stress fractre, CECS, nerve entrapment, lumbar rediculopathy) Risk factors: runners with old/less absorbing shoes, training errors, hill training, over pronation)
38
Treatment of tibial stress syndrome
reduce activity 50% change shoes PT
39
Tibial stress fractures
overuse, common in athletes/military recruits propagation of microfractures form repetitive loading Tibial stress syndrome>stress response/reaction>fracture
40
Evaluation of Tibial Stress Fractures
radiography, dreaded black line, MRI- possible bone marrow edema
41
Treatment of Tibial Stress Fracture
Activity modification, avoid NSAIDS, consider BM stim intramedullary tibial nail if fracture violates anterior cortex
42
Syndesmosis
AITFL PITFL TTFL IOM
43
What is the weakest ligament of the ankle laterally?
Anterior talofibular ligament F: restraint to inversion in plantarflexion injured 85% of the time in lateral ankle sprains
44
What is the strongest lateral ligament?
PTFL, rarely injured
45
Calcaneal fibular ligament
primary restraint to inversion in neutral position injured in 20-40% of lateral sprains
46
Accessory Ossicles
secondary ossification centers that remain separated from the normal bone
47
Sesamoids
bones incorporated into tendons and move with normal tendon motion
48
Most common Sesamoids
``` Hallux 100% Os Peroneum (talonvaicular) 9-20% Os Trigonum (behind heel) 10-25% ```
49
Lateral Ankle Sprains
Injury to lat ankle ligament with plantarflexion and inversion (AL capsule>ATFL>CFL) Risk Factors: patient related- limited DF, decreased proprioception, balance deficiency environment- indoor court sports, previous injury Presentation: pain, swelling, echymosis, +ant drawer, radiograph?
50
Classification of Lat ankle Sprain
1: none to ATFL stretch, minimal soft tissue 2: ATFL stretch to tear, moderate soft tissue 3: ATFL+/- CFL tear, severe soft tissue
51
Treatment of Lat ankle Sprain
1/2: short immobilization, early mobilization (PT) 3: 10 days casting followed by boot, then mobilization; early surgery not indicated Complications: - missed fractures - osteochondral lesions - injury to tendon - injury to syndesmosis - tarsal coalition - impingement syndrome
52
Medial Ankle Sprain
Injury to medial ligaments with EVERSION, rare, radiography shows avulsion injury to medial malleolous, MRI, Mostly non-op treatment If late surgery, perform stress radiography after fibular fixation
53
Syndesmotic Injury
Internal rotation on tibia with a fixed foot Cotton test, squeeze test, ER stress test Radiography may show widening of synd: >6mm TF clear space on xray, MRI if not seen
54
Treatment of Syndesmotic Injury
RICE preferred RTP is 2x low ankle sprain (10-52 days) Surgical fixation for obvious diastasis or high level athletes (screw or suture and buttons)
55
Lisfranc Injury
Tarsometatarsal joint injury from sprain to dislocation Mechanism: axial loading or twisting on a plantarflexed foot or direct axial loading often missed, high level of suspicion
56
What imaging should be performed in suspicion of Lisfranc?
WEIGHT BEARING AP, obl, and lat view of ankle CT or MRI to confirm dx Findings: widening, fleck sign
57
Treatment of Lisfranc
Reduction is key to long-term outcome Nondisplaced: short leg non-weightbearing cast 6 weeks Displaced: reduction and rigid internal fixation of 1-3 TMTs and temp fixation for TMT 4-5
58
Turf Toe
Hyperextension of plantar plate of 1 MTP normal xray, MRI for soft tissue damage Initial immobilization with early mobilization to prevent stiffness May RTP with stiff sole shoe Avoid injection no surgery usually
59
Sesamoid disorders
``` Fracture, sesamoiditis, AVN, OA Bipartite sesamoid (97% tibial, 25% bilateral) ``` Radiography and MRI to confirm Conservative treatment: modified shoes with padding, NSAIDs, PT, injections, boot if necessary Surgery=sesamoidectomy
60
Achilles Tendon Rupture
Sharp dorsiflexion force onto a tensioned tendon creating a rupture through a region of previous degeneration in the watershed area (4-6 cm from insertion) Missed Dx in 24% of patients Thompson test Treatment controversy: operation: lower rerupture rate, higher complication rate
61
Plantar Fasciitis
Inflammation of plantar aponeurosis at its insertion at calcaneus risks: obesity, decreased ankle dorsiflexion, endurance activities Prestation: posteromedial hell pain that is worst with 1st step in morning Exam: TTP at planter fascia insertion Treatment: pain control, splint, stretching Surgical release of plantar fascia if non responsive after nine months
62
Hallux Valgus
aka bunion complex deformity of big toe, progressive ADDUCTOR HALLICUS is deforming force Treatment: shoe wear modification, surgical correction depending on severity
63
Normal angles of hallux
HVA <15* IMA <9* DMAA <10* HVI <10*

*Surgery (9 decks)

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