LE- Ankle & Foot fractures and sprains

A phalanx fracture typically heals

3-4 wks

A metatarsal fracture typically heals

4-6 wks

A distal tibia/fibula fracture typically heals

6-8 wks

Ankle fracture types =

uni / bi / tri - malleolar

A uni-malleolar fracture =

MED (Fx of Tibia)

or

LAT ( Fx of fibula)

A bi-malleolar fracture =

MED and LAT

(both distal tibia/fibula)

A tri-malleolar =

MED, LAT, POST

(distal tibia, fibula, and POST malleolus)

Trimalleolar involves

high impact / possible syndesmosis injury

_________ fx & ankle dislocations are twice as likely to have associated chondral lesions than _____ fx

Trimalleolar; bimalleolar

Chondral Lesions may be direct result of a

original trauma / indirect overtime malalingnment due to a fracture

Which of the following statements about possible chondral injuries is not true?

Increased risk of RA in the future

What are the goals of fracture management?

relieve P!

satisfactory alignment & union

Which of the following is commonly used for fracture fixation?

screws, plates, pins, nails

What is the primary goal of fracture fixation?

Compress and align fracture segments

Fracture fixation allows bone healing through:

Direct osteonal migration, maintaining bone length, and preventing further soft tissue damage

Which fracture may not require fixation because it is stable?

simple fibular fracture

In the assessment of Fx, clinicians should strive to understand all of the following except

univovled structures

When evaluating a fracture, what other structures may be involved?

bones, ligaments, chondral

What of the following statements about research on ankle-specific fracture is not true?

Late motion exercise (P, AA, AROM, isometrics)

Which of the following is typical presentation of a patient with an ankle or foot fracture?

laxity

What is likely in the early exam (0-4 wks) for a fracture?

edema, global loss of motion, MMT weakness

if ankle AROM < PROM for a fracture, should you apply resistance?

No resistance; too risky

If ankle AROM = PROM, can you apply resistance?

cautious, light resistance

What are some cautions and considerations that should be taken for a fracture in the early exam?

MMT knee/hip, balance, gait/function

What is likely during a later exam of a fracture?

global loss of foot/ankle ROM and ↓ gastroc length

Weakness of _____/____ and reduced ______ are the norm in the later exam for a fracture.

ankle/glutes; balance

Along with fractures what other structures can be injured?

soft tissues → check for lig laxity in early/late

Rehab of a fracture include all of the following except?

Heel drop

Early rehab of a Fx should focus on all of the following except

distal tibiofibular joint & soft tissue for stiffness

Joint mobilization for fracture rehab includes

talocrural (POST/distraction)

intertarsal

Joint mobilization for fracture rehab should progress to

grade 3-4

Soft tissue mobilization for fracture rehab includes

plantar foot/FHL, POST calf, edema

Which of the following statements is not true about weaning off of CAM walker after a fracture?

pts should work on 4 direction ankle strengthening with emphasis on DF.

If using a heel lift perform

prophylactic gastroc stretches on the C/L side to prevent contracture formation

Each pound of weight loss decreases

stress at knee/ankle 4-fold

Better alignment for a fracture =

better

For a fracture, atrophy resolution lags behind

torque resolution

What correlations with function are seen with outcomes of fracture?

WB DF, single leg stance, # of heel raises

What are the outcome expectations for a fracture in the first 3 months?

2 months normal gait on levels/3 months post-op normal ADLs/function

What are the outcome expectations for a fracture in the first 6 months post-op?

80% function

What are the outcome expectations for a fracture in the 1yr post-op?

90% had 90% RTF

How long may outcome expectations improve for a fracture?

up to 24 months

What are the top five (in order) structures involved in ankle sprains?

ATF, Fibularis, chrondral, ATF+CFL, deltoid

What other structures are not commonly involved in ankle sprains?

syndesmosis, ATF/PTF

Which of the following is not a risk factor for ankle sprain?

INC proprioception

Patients with chronic ankle sprains are likely to have

weakness, DEC muscular endurance, and reduced DF ROM

An examination of the patient’s Hx for an ankle sprain should include all of the following except

future assessments/interventions

An ankle exam should start with ______ then work through ______.

big picture look; relevant components

LAT ankle sprains are often involved with

PFed ankle moving into INV and fibulari attempting to limit INV

Sometimes fibulari overcorrect when attempting to limit INV, potentially causing

a deltoid sprain

A LAT ankle sprain can occur with

osteochondral lesions (especially on talus)

or extreme ER on fixed foot

Mechanical instability of a lateral ankle sprain is describe in terms of

anatomic laxity

Which of the following statements is not true about the functional instability of a lateral ankle sprain?

functional instability is aka acute ankle sprain

Which of the following is not a risk factor of lateral ankle sprains?

loss of DF (ankle is closer to closed packed position = more vulnerable)

What structures are involved in a grade 1 LAT ankle sprain?

ATF

Which of the following is not a characteristic of grade 1 LAT ankle sprain?

A/P EVER painful

What structures are involved in a grade 2 LAT ankle sprain?

ATF

Possible fibulari

Which of the following is not a characteristic of grade 2 LAT ankle sprain?

(+) MED talar tilt test

What structures are involved in a grade 3 LAT ankle sprain?

ATF, CFL

Probable fibulari

Which of the following is not a characteristic of grade 3 LAT ankle sprain?

Less ecchymosis and swelling

What is the general recovery for grade 1-3 LAT ankle sprain?

1 (7 d), 2 (15 d), 3 (31-55 d)

Patient with serious sprains is likely to experience

DEC speed, stance time. P! near end range DF

What are the special tests for ATF?

ANT drawer/reverse ANT drawer

Which of the following is not a typical differential diagnosis for LAT ankle sprains?

MED ankle impingement

When is a LAT lig repair indicated?

Only if chronic ankle instability persists despite rehab

Edema management of an ankle sprain includes all of the following except

distraction

Whicj ankle sprain grade should a CAM boot be used?

Grade 3

Immediate WBing after LAT lig reapir provides

better outcomes

Intervention of ankle sprains include early controlled movement from

end range DF to 30º PF

(4 direction isometrics)

Which of the following is not a focus to strengthen in the open chain and closed chain for rehab of an ankle sprain?

DF (OC/CC)

Which of the following is not a component of balance training following an ankle sprain?

progress from multi planes to 1

What tends to be more sucessful in treatment of an ankle sprain?

conservative > surgical

What surgeries are used for a lateral ankle sprain?

Brostom or Modified Brostom

Nonanatomic repairs (Watson-Jones or Evans)

Brostom or Modified Brostom =

open capsule to treat osteochondral lesions

Which of the following is not a characteristic of Brostom or Modified Brostom?

higher incidence of DJD

Nonanatomic repairs (Watson-Jones or Evans) is better for

bigger athletes or failed reconstructions

Which of the following is not a precaution of Nonanatomic repairs (Watson-Jones or Evans)?

Ankle PROM 2-4 wk after surgery

Pt can start light plyos for ankle sprains around

8-12 wks

Pt can start straight running at

12 wks

Pt can start cutting at

16 wks

After surgery, reinjury of ankle sprain is higher in those

returning to high level sport

(so graded rehab necessary)

Rerupture after a year of surgery for an ankle sprain is

rare

What is the strongest lateral ankle ligament?

PTF

PTF provides

rotatory stability

50% of ATF injuries are _________

the other 50% are _______

avulsion from the fibula

midsubstance tears

What serves a physical block to eversion sprains?

fibula

Deltoid ligament is

stout and multidirectional

A deltoid sprain can occur with

ankle eversion w/ or w/o ER

or osteochondral lesions

What is the special test for MED ankle sprain?

LAT talar tilt test (EVER stress test)

A syndesmotic sprain =

a high ankle sprain

Which of the following is not a typical structure of a Syndesmotic (“High Ankle”) Sprain?

ANT SUP tibiofibular ligament

A syndesmotic ankle sprain is typically a result of

forceful ER of DFed foot (deltoid might be injured0

Where is tenderness expected for a syndesmotic sprain?

ANT INF tibiofibular lig

What is injured first in a syndesmotic ankle sprain?

weaker ATF

What injury follows the ATF in a syndesmotic sprain>

stong PTF, interosseous & transverse tibiofibular ligament

Which of the following is not a special test for Syndesmotic Sprain?

IR test

Which of the following is not a special test for an ankle sprain?

POST drawer

Why is balance training important during a syndesmotic sprain rehabilitation?

It improves proprioception and stability

Proprioception deficits for patients with ankle sprains is often described as

“giving way”

Balance for patient with ankle sprain is typically worse

at/near end ranges (Landing in high-risk positions)