Lower Leg/Ankle/Foot Injuries Flashcards
(79 cards)
List the structures of the anterior compartment of the lower leg.
EHL, ED, AT, Peroneus tertius, Deep peroneal N.
Name the lateral structures in the lower lower leg compartment.
- Peroneus Longus
- Peroneus Brevis
- Superficial Peroneal nerve
Name the Deep Posterior structures in the lower lower leg compartment.
- FHL
- FDL
- PT
- Posterior Tibial N
Name the superficial posterior structures in the lower lower leg compartment.
- Gastrocneumius
- Soleus
- Sural nerve
What are some associated injuries from a tibial plateau fracture?
Compartment syndrome
meniscal injury
Name the different radiographs views for a supsected tibial plateau injury
- AP
- Lateral
- Internal
- External Oblique
Reasons to get ortho involved for a tibial plateau fracture.
- Compartment Syndrome
- Ligamentous injury
- Displaced/depressed
___ > mmHG for diagnosis of Acute Compartment Pressure Syndrome.
30
What is the formula for pressure testing for Acute Compartment Pressure?
< 30 = DBP- CP
Pedowitz Formula for Chronic Exertional Compartment Syndrome
Pre > 15 mm Hg
1 min post >30 mmHg
5 min post> 20 mm Hg
RTP following fasiotomy for Chronic Exertional Compartment Syndrome
6-12 weeks
Runner comes in with bilateral diffuse medial tibial shaft tenderness. Worst with exertion but can tough it out to comeplete runs. Diffusely tender on along medial tibial shaft.
What is the diagnosis and what is in the differential?
Medial Stress Syndrome
Compartment Syndrome should be in differential however once the pain starts while running these patients cannot push through it and must stop.
Tibial Stress Fracture- more localized tenderness
How can an MRI be useful for medial tibial shaft pain in runner who just started training for marathon?
MRI can differentiate b/t stress fracture and stress sydnrome.
What is a vascular condition that can often present like compartment syndrome in usually a male athlete < 40 yr. Provacative pain on exam with passive ankle dorsiflexion and active ankle planterflexion.
Popliteal Artery Entrapment
Definite study to confirm popliteal artery Entrapment
Arteriography
Doppler US exam with high false positive
Treatment for popliteal artery entrapment
surgical release
Where is the most common place for tibial stress fractures?
Middle 1/3 posteromedial tibia
Discuss the pros and cons of the following imaging modalities for Tibial stress fractures:
XRAY
Bone Scan
MRI
- Xray- often normal for 2-3 weeks
- Bone Scans are highly sensative with low specificity
- MRI good for grading.
For Popliteal Artery Entrapment give the 3 values of POST ABIs that would
a: be suggestive
b: indicative
A drop of ____ mmHg from baseline is also indicitive and usually correlates between 0.1-0.2 ABI)
A- ABI < .75 suggestibve
B- ABI <.50 indicative
Drop of 15 mmHg from baseline = (0.1-.0.2)
Describe the Fredericson Grading System for Medial Tibial Stress Syndrome and how it correlates with RTP
Grading system based on MRI
- Grade 1 - persosteal edema —–> RTP 2-3 weeks
- Grade 2- 4a ( progressive marrow edema changes with intracortical signal changes(4a) RTP 6-7 weeks
- Grade 4b- linear region of intracorticla signal change—-> RTP 9-10+ weeks
Is this tibial stress fracture high risk or low risk?
What is the treatment?
High risk ( tension side) - the dreaded black line. Anterior tibia
Treatment: NWB, cast vs. pneumatic bracing for 6-12 months. Depending on the level of the athlete this could require bone graft vs. intra-medullary nailing (faster RTP)
Catagorize this tibial stress fracture as high or low risk?
Low- posteriormedial tibia ( compression side)
Low Risk
Most common stress fx site in athletes
AVOID NSAIDS
Correct training/technique errors
RTP for low risk tibial stress fractures vs. high risk stress fractures
Low Risk (posteriormedial) - 2-6 weeks when sx resolve
High Risk( anteriormedial) 6-12 months
Describe the MOI from a fibular fracture?
Varus stress at knee
or
ankle in ER ( Maisonneuve fx)
