Ankle Injuries

Question 1

Lateral Malleolus Fracture

Answer 1

• The most common
• Occurs with a break to the malleolus (knobbly bit on the outside)
• No surgical intervention, will heal on its own

Question 2

Bimalleolar Fracture

Answer 2

• 2nd most common fracture
• Breaks both the medial and lateral malleolus (both knobbles)
• The ankle joint is unstable AAR
• Needs surgery

Question 3

Trimalleolar Fracture

Answer 3

• Breaks to the lateral, medial and posterior malleolus
• These bones provide the framework that the ligaments attach to
• Requires surgery and intensive physiotherapy

Question 4

Pilon Fracture

Answer 4

• Break to the bottom of the tibia (similar to a tib fib fracture but lower down)
• Typically occurs from a high MOI

Question 5

Common MOIs of Ankle Fractures

Answer 5

• RTCs
• Falls - from height or standing
• Twisting/rotating/rolling mechanisms

Question 6

Signs and Symptoms of Fracture

Answer 6

• So of throbbing pain
• Swelling
• Bruising
• Tenderness
• Deformity
• Inability to weight bear

Question 7

6Ps

Answer 7

Pallor - deathly pale, maybe mottled in children
Paraesthesia - due to pressure on nerves
Pulselessness - caused by swelling, rupture or occlusion to blood supply
Pain
Paralysis - loss of active/range of movement
Perishing cold - distally cold to touch indicates poor perfusion

Question 8

What is Compartment Syndrome

Answer 8

A condition where an increase in pressure inside a muscle restricts blood flow and causes pain

Question 9

What Things to Look for in Compartment Syndrome

Answer 9

• Evidence of the 6Ps
• Disproportionate pain relative to the injury
• Palpable tension across the skin
• Swelling of an anatomical compartment

NOTE: distal perfusion may still be seen, loss of pulse is a late sign. Some injuries may require surgery so follow local guidelines carefully when transporting

Question 10

Normal ROM

Answer 10

• Flexion/Extension - up/down
• Inversion/Eversion

Question 11

Ottowa Ankle Rules

Answer 11

• Base of the 5th metatarsal
• Posterior edge of lateral malleolus
• Navicular bone
• Posterior edge of the malleolus
• Inability to weight bear immediately after injury/4 steps

Question 12

Risk Factors for Ankle Injuries

Answer 12

• Participating in high-impact sports
• Osteoporosis/other bone density conditions
• Poor mobility
• Using improper techniques/sport equipment
• Suddenly increasing activity level
• Obstacles and trip hazards at home

Question 13

Managment of Open Fracture

Answer 13

• Consider taking photographs before further treatment
• Do not irrigate the wound, remove any gross contaminants
• Where possible apply a saline soaked dressing covered with a transparent film like the sterile field from the blast dressing
• Correct any gross misalignment and splint
• Give co-amoxiclav IV/IO
• Consider traction

Question 14

What Classes as a Limb Threatening Injury

Answer 14

• Severe pain (even with analgesia)
• Loss of pedal pulse and/or significantly delayed CRT
• Critical Skin; pale, white, discoloured or blanching
• Risk of closed fracture becoming open
• Haemorrhage in the presence of open fractures, amputation and/or degloving injuries
  These are the patients you are pre-alerting to hospital with

Question 15

Vacuum Splinting

Answer 15

• Remove jewellery before splinting as can swell around it making it more difficult to remove late, it can also cut off blood supply
• Splinting can provide cushioning to aid in extrication an transportation of the patient
• It will also be a form of pain relief as the cushioning effect can provide pressure that triggers a dulling of pain response, it will also keep the limb still to avoid any movement in transport that will cause pain

Question 16

Alignment Management of Fractures

Answer 16

Some grossly deformed ankle fractures may benefit to some level of realignment. When to attempt:

• Signs of vascular impairment
• Absent or weak distal pulse
• Significantly prolonged cap refill
• Critical skin over the fracture sight (blanching or discolouration)

Question 17

List of Differentials Ankle Fracture

Answer 17

• Tendonitis
• Impingement
• Achilles Rupture - popping and simmonds
• Sprain or Strain