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Acute care Ankle Fractures and how to treat them
- 1. FOOT AND ANKLE FOR ST3 NJ MACDONALD
- 6. HISTORY TOP TIPS • Mechanism of injury – think of forces involved • Twisting? • Position of the foot? • Invisible sniper? • Weight bear after? • Happened before? • What medications has the patient taken to help? • Beware the referred pain! • Systemic symptoms? • Does the hx correlate - Diabetic??
- 7. EXAMINATION – LOOK • Weight bearing • Toe weight bearing? • Swelling? • Position of the foot? • Redness if so wear? • Ecchymosis? • Sole of the foot? • Classic sprained ankle pattern?
- 8. EXAMINATION FEEL • Systematic examination of the foot • Start in the non painful area –palpate phalanges – metatarsals, malleoli. Don’t forget proximally! • Swelling – • Which side – Medial, Lateral, both?? • Fluctuance/bogginess • Pain – Medial – lateral - • Pulses/CRT • Sensation
- 9. EXAMINATION MOVE • Active/Passive – Compare to other side • Don’t force something that’s painful • Anatomy guides your special tests • Squeeze the MT • Ballot the LisFranc joint.
- 10. OTTAWA SHMOTTAWA
- 12. WEBER CLASSIFICATION • Type A (38%) • Below level of joint • Stable • Type B (52%) • At or above level of joint to top of syndesmosis • Stable or Unstable • Type C (10%) • Above level of syndesmosis • Unstable
- 13. Lauge-Hansen Classification Supination Supination-adduction SAD Supination-external rotation SER Pronation-abduction PAB Pronation-external rotation PER (Maisonneuve) Pronation LAUGE-HANSEN CLASSIFICATION
- 14. LAUGE-HANSEN CLASSIFICATION Lauge-Hansen SAD SER PAB PER I-II I - IV I - III I - IV
- 15. BUT WHY COMPLICATE THINGS? 1. Yes Lauge Hansen is slightly more involved 2. But! It will guide your reduction! 3. Videos are online and make it easier…
- 16. Radiographic Criteria XR Normal MCS <5mm TFCS (Syndesmosis-A) <5mm TFOL (Syndesmosis-B) >5mm (>1 on mortise) Fib lenth Ball sign Talocrural Angle 83° Med mall disp. < 2mm Lat mal disp. < 2mm Post mall disp < 25%, 2mm
- 17. CASE 1 • 30 yr old playing lacrosse – bad tackle • What are your concerns? • Weber Classification? • Given that – any other views SER II or SE
- 18. SIMPLE ANKLE FRACTURE? – THE WEBER B – WEIGHT BEARING VIEWS REVEAL! SER II or SER IV ? SER II or SER IV ?
- 19. CASE II • 45 year old stepping out of the pub • Painful swollen • Classification? • Stable? • Initial management?
- 20. CASE III • 75 yr old stripped down last step of stairs • Painful swollen foot • Any specific questions? • Any specific tests? • Advice/mobilise?
- 21. CASE IV • 40 yr old female – pain after netball competition • Examination? • Pain? • Patient expectation?
- 22. CASE V • 65 year old tripped in the garden • Painful swollen – tender where? • Classification? • Any bony injury? • Initial management? • Any Further Imaging?
- 23. CASE VI • 85 year old tripped getting out of car • Painful swollen – tender where? • Classification? • Is this stable? • Initial management? • Any Further Imaging?
- 24. SUMMARY • When in doubt NWB • Plaster is your friend (again…) Post reduction views • If they can weight bear for consider getting weight bearing views. • In the case of the swollen painful foot – refer on to VFC especially if over 1st or 2nd MT • Keep DDx in mind if no trauma. Diabetic foot? Charcot?