Lecture 5 - sprains

Question 1

definiton of sprain

Answer 1

Represent a joint trauma that occurs at the level of the capsuloligamentous apparatus of the respective joint and is not accompanied by the loss of the normal anatomical relationship between the joint surfaces.

Question 2

classificaiton of sprains

Answer 2

• grade 1
  ○ Broken ligament
  ○ Mechanically weaker
  ○ AKA ligament strain
  • Grade 2
    ○ Partial macroscopic tear of the accompanying ligament
    ○ Local hematoma
    ○ Ecchymosis
  • Grade 3
    ○ Complete treat of the ligament
    ○ Hematoma and ecchymosis
    Can lead to joint injury and dislocation

Question 3

mechanism of sprains

Answer 3

Stressed mechanically beyond the physiological limit
Forced into a position
combination

Question 4

diagnosis of sprains

Answer 4

physical examination
pain man factor
functional impotence
contralateral examination
image is mandatory
MR is very useful

Question 5

mechanism of sprained ankle

Answer 5

• Indirect
  
  • Forced ankle into varus
  • The varus mainly damages the calcaneofibular ligament
    If the foot is in a more flexed position the anterior talofibular ligament can be more involved in the sprain

Question 6

clinical examination of the ankle sprain

Answer 6

4. Hematoma at the level of ant.talofibular lig.
   “pigeon egg”
   
   5. Forced inversion- grove- Clayton sign
   6. Early ecchymosis
   7. Diffuse swelling
5. Anterior drawer

Question 7

explain the mechanism of the lateral collateral ligament

Answer 7

forced varus in neutral position
Malleolar fractures
Talocalcanean trauma

○ Forced varus in flexion
Anterior talofibular lig stretched

Question 8

the degrees of the anterior talofibular ligament in front view

Answer 8

normal - 5-10 degrees
instability - 10-15 degrees
ATF + CF - 20-25 degrees
all three ligaments 25-45 degrees

Question 9

Lateral view in anterior drawer position

Answer 9

distance between the post. margin of the
tibial pilon and center of trochlea
- 5 mm – normal (congenital laxities)
- >8 mm : ATF lesion
- not specific - for CF and PTF

Question 10

complications of LCL

Answer 10

1. NEUROLOGICAL
   
   • fibular n.
   • tibial n.
     2. OSTEOCONDRAL LESIONS
   • talus : osteocondral fractures
     open reduction or removal
     3. OLD INSTABILITY
     4. ALGODISTROFIA
2. POSTOPERATIVE COMPLICATIONS

Question 10

treatment of ankle sprains

Answer 10

1. REFRIGERATION, ANTALGIC
   MEDICATION, REST
   
   2. NO WEIGHT-BEARING
   3. “STRAPPING”
   4. “TAPING”
   5. CAST
   6. SURGICAL TREATMENT

Question 11

what are the associated lesions of the sprains in MCL of the ankle

Answer 11

• Fracture of the fibular malleolus (bimalleolar fracture)
  Tibiofibular diastasis

Question 12

clinical pictrue of MCL sprains

Answer 12

pain
eccymosis
intra-articular entrapping

Question 13

what are the old instabilities in ankle sprains

Answer 13

1. Capsular gap at the anterior margin of the
   fibular malleolus
   2. ATF lig. healed elongated
   3. Lateral premalleolar sack
   4. Osteocondral fractures
   After lesions at the malleolus-ligament junction

Question 14

mechanism of knee sprains

Answer 14

• Sport accidents
  
  • Knee forced into valgus
    The medial collateral ligament can tear from its proximal insertion on the medial femoral condyle (most common), from its distal (tibial) insertion, or from its middle (least common).

Question 15

grade classification of knee sprains

Answer 15

Grade I (Mild) – Stretch or Minor Tear
Grade II (Moderate) – Partial Tear
Grade III (Severe) – Complete Tear or Ruptur

Question 16

mechanism of prain in antero external cruciate liagement of the knee

Answer 16

• Indirect
  
  • hyperextension of the knee, encountered especially during sports games, in which the ligament is damaged by the forced “impingement” of the edge of the intercondylar incision on it
  • “twisting of the knee”, by a cracking sensation
    Intra articular effusion - blood in most cases