DOCSLIB.ORG

High Ankle Sprains

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
High Ankle Sprains ONLINE EXCLUSIVE John T. Nickless, MD; Jeremy A. Alland, MD High ankle sprains: Division of Primary Care Sports Medicine, Department of Orthopedic Surgery, Rush Easy to miss, so follow these tips University Medical Center, Chicago Misdiagnosis can result in increased loss of play time and [email protected] chronic ankle dysfunction. Here are the physical exam The authors reported no potential con ict of interest relevant maneuvers and imaging options to consider. to this article. CASE u PRACTICE A 19-year-old college football player presents to your outpa- RECOMMENDATIONS tient family practice clinic after suffering a right ankle injury ❯ Maintain a high level of during a football game over the weekend. He reports having suspicion for syndesmotic his right ankle planted on the turf with his foot externally ro- injury in any athlete tated when an opponent fell onto his posterior right lower ex- describing an external rotation or tremity. He reports having felt immediate pain in the area of hyper-dorsifl exion the right ankle and requiring assistance off of the fi eld, as he ankle injury. A had diffi culty walking. The patient was taken to the emergency department where x-rays of the right foot and ankle did not ❯ Obtain weight-bearing anteroposterior- and show any signs of acute fracture or dislocation. The patient was mortise-view ankle x-rays diagnosed with a lateral ankle sprain, placed in a pneumatic in all cases of suspected ankle walking brace, and given crutches. syndesmotic injuries. A high ankle sprain, or distal tibiofi bular syndesmotic in- ❯ Consider stress x-rays of the aff ected ankle, contralateral jury, can be an elusive diagnosis and is often mistaken ankle x-rays for comparison A for the more common lateral ankle sprain. Syndesmotic views, or advanced imaging injuries have been documented to occur in approximately 1% with magnetic resonance to 10% of all ankle sprains.1-3 Th e highest number of these in- imaging (MRI) or juries occurs between the ages of 18 and 34 years, and they are computed tomography more frequently seen in athletes than in nonathletes, particu- if initial x-rays are larly those who play collision sports, such as football, ice hock- unrevealing. A ey, rugby, wrestling, and lacrosse.1-9 In one study by Hunt et al,10 ❯ Treat stable syndesmotic syndesmotic injuries accounted for 24.6% of all ankle injuries in injuries with conservative National Collegiate Athletic Association (NCAA) football play- measures and ers. Incidence continues to grow as recognition of high ankle rehabilitation. A sprains increases among medical professionals.1,5 Identifi cation Strength of recommendation (SOR) of syndesmotic injury is critical, as lack of detection can lead to A Good-quality patient-oriented extensive time missed from athletic participation and chronic evidence ankle dysfunction, including pain and instability.2,4,6,11 B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, Back to basics: opinion, disease-oriented A brief anatomy review evidence, case series Stability in the distal tibiofi bular joint is maintained by the syndesmotic ligaments, which include the anterior inferior MDEDGE.COM/FAMILYMEDICINE VOL 68, NO 3 | APRIL 2019 | THE JOURNAL OF FAMILY PRACTICE E5 Nickless0419.indd 5 4/3/19 10:54 AM tibiofibular ligament (AITFL), the posterior sation of instability with weight bearing on inferior tibiofibular ligament (PITFL), the the affected ankle, or have persistent symp- transverse ligament, and the interosseous toms despite a course of conservative treat- ligament.3-6,8 This complex of ligaments stabi- ment. Also, they can have a variable amount lizes the fibula within the incisura of the tibia of edema and ecchymosis associated with and maintains a stable ankle mortise.1,4,5,11 their injury; a minimal extent of swelling or The deep portion of the deltoid ligament also ecchymosis does not exclude syndesmotic adds stability to the syndesmosis and may be injury.3 disrupted by a syndesmotic injury.2,5-7,11 A large percentage of patients will present with a concomitant sprain of the lateral liga- ments associated with lateral swelling and Mechanisms of injury: bruising. One study found that 91% of syndes- From most common to less likely motic injuries involved at least 1 of the lateral The distal tibiofibular syndesmosis is disrupt- collateral ligaments (anterior talofibular liga- ed when an injury forces apart the distal tib- ment [ATFL], calcaneofibular ligament [CFL], iofibular joint. The most commonly reported or posterior talofibular ligament [PTFL]).12 means of injury is external rotation with hy- Patients may have pain or a sensation of in- per-dorsiflexion of the ankle.1-3,5,6,11 With ex- stability when pushing off with the toes,5 and cessive external rotation of the forefoot, the patients with syndesmotic injuries often have Trauma talus is forced against the medial aspect of tenderness to palpation over the distal an- causing ankle the fibula, resulting in separation of the distal terolateral ankle or syndesmotic ligaments.7 syndesmotic tibia and fibula and injury to the syndesmotic ❚ A thorough examination of the ankle, injuries may be ligaments.2,3,5,6 Injuries associated with ex- including palpation of common fracture sites, associated with ternal rotation are commonly seen in sports is important. Employ the Ottawa Ankle Rules Weber B that immobilize the ankle within a rigid boot, (see http://www.theottawarules.ca/ankle_ or Weber C such as skiing and ice hockey.1,2,5 Some au- rules) to investigate for: tenderness to palpa- distal fibula thors have suggested that a planovalgus foot tion over the posterior 6 cm of the posterior fractures or a alignment may place athletes at inherent risk aspects of the distal medial and lateral malle- Maisonneuve for an external rotation ankle injury.5,6 oli; tenderness over the navicular; tenderness fracture. Syndesmotic injury may also occur with over the base of the fifth metatarsal; and/or hyper-dorsiflexion, as the anterior, widest por- the inability to bear weight on the affected tion of the talus rotates into the ankle mor- lower extremity immediately after injury or tise, wedging the tibia and fibula apart.2,3,5 upon evaluation in the physician’s office. Any There have also been reports of syndesmotic of these findings should raise concern for a injuries associated with internal rotation, possible fracture (see “Adult foot fractures: A plantar flexion, inversion, and eversion.3,5,11 guide,” at http://bit.ly/2Tm4Siv) and require Therefore, physicians should maintain a high an x-ray(s) for further evaluation.13 index of suspicion for injury to the distal ❚ Perform range-of-motion and tibiofibular joint, regardless of the mechanism strength testing with regard to ankle dor- of injury. siflexion, plantar flexion, abduction, ad- duction, inversion, and eversion. Palpate Presentation and evaluation the ATFL, CFL, and PTFL for tenderness, as Observation of the patient and visualization these structures may be involved to varying of the affected ankle can provide many clues. degrees in lateral ankle sprains. An anterior Many patients will have difficulty walking -af drawer test (see https://www.youtube.com/ ter suffering a syndesmotic injury and may watch?v=vAcBEYZKcto) may be positive with require the use of an assistive device.5 The injury to the ATFL. This test is performed by inability to bear weight after an ankle injury stabilizing the distal tibia with one hand and points to a more severe diagnosis, such as using the other hand to grasp the posterior an ankle fracture or syndesmotic injury, as aspect of the calcaneus and apply an anterior opposed to a simple lateral ankle sprain. Pa- force. The test is positive if the talus translates tients may report anterior ankle pain, a sen- forward, which correlates with laxity or rup- E6 THE JOURNAL OF FAMILY PRACTICE | APRIL 2019 | VOL 68, NO 3 Nickless0419.indd 6 4/3/19 10:54 AM HIGH ANKLE SPRAINS ture of the ATFL.13 The examiner should also FIGURE 1 palpate the Achilles tendon, peroneal ten- Maisonneuve fracture dons just posterior to the lateral malleolus, and the tibialis posterior tendon just posteri- or to the medial malleolus to inspect for ten- derness or defects that may be signs of injury to these tendons. ❚ An associated Weber B or C fracture? Trauma causing ankle syndesmosis injuries may be associated with Weber B or Weber C distal fibula fractures.7 Weber B fractures oc- cur in the distal fibula at the level of the ankle joint (see FIGURE 1). These types of fractures are typically associated with external rotation injuries and are usually not associated with disruption of the interosseous membrane. Weber C fractures are distal fibular frac- tures occurring above the level of the ankle RUSH, RUSH UNIVERSITY MEDICAL CENTER, CHICAGO AT OF: MIDWEST ORTHOPEDICS ALL IMAGES COURTESY joint. These fractures are also typically associ- ated with external ankle rotation injuries and include disruption of the syndesmosis and deltoid ligament.14 Also pay special attention to the proxi- mal fibula, as syndesmotic injuries are commonly associated with a Maisonneuve fracture, which is a proximal fibula fracture associated with external rotation forces of the ankle (see FIGURE 1).1,2,4,11,14,15 Further workup should occur in any patient with the possibil- ity of a Weber- or Maisonneuve-type fracture. ❚ Multiple tests are available to inves- tigate the possibility of a syndesmotic in- jury and to assess return-to-sport readiness, including the External Rotation Test, the Squeeze Test, the Crossed-Leg Test, the Dor- siflexion Compression Test, the Cotton Test, the Stabilization Test, the Fibular Transla- tion Test, and the Single Leg Hop Test (see TABLE1-3,5,6,16,17). The External Rotation Test is noted by some authors to have the highest This anteroposterior x-ray of the left tibia, fibula, and interobserver reliability, and is our preferred ankle demonstrates a Maisonneuve fracture (solid white arrow), as well as increased medial clear space 2 test.
Load more

Recommended publications
  • Opso Summer 2014
    The Lower Extremity OPSO Summer Primary Care CME Conference August 15, 2014 K. Turner Slicho, DO Case Presentation 53-year-old Caucasian female complains of left sided SI pain described as an ache w/o radiation Initial onset of pain was 25 years ago, when her back “seized up” bending over to put her toddler to bed. Infrequent issues over the next 10-15 years, then began to be more problematic Now, constant pain over the last 2 years Numbness in a small area of left shin. Denies weakness, tingling Case Presentation Unable to sit for long periods, bend over, cross legs comfortably Does not lift her grandson Does not brush teeth bending over without holding the sink No longer exercising due to pain 15 chiropractic session with two different providers over 2 years with “absolutely zero effect” on her pain 12 physical therapy sessions with marginal effect Case Presentation PMHx: Unremarkable** FHx: Cancer, DM, Food Allergies, Meniere’s Disease, Restless leg syndrome, Ulcerative colitis PSHx: C-section 1990, Appendectomy 2009, Hernia repair 2005 Meds: Diclofenac 100mg BID Case Presentation X-Ray: L4-L5 degenerative changes. Normal pelvis and SI joints bilaterally MRI: mild degenerative changes L3-S1 without significant neuroforaminal or spinal stenosis Neurosurgical evaluation : non-surgical back Case Presentation Gen: NAD, A&O x 3 Neuro: 2+/4 DTR’s, Strength 5/5, no motor deficits, mild sensory loss in left superio-lateral shin Extremities: no edema, ecchymosis, peripheral pulses normal Case Presentation: Somatic Dysfunction findings Cervical: Left posterior OA facet restriction Lumbar: L5 ERSl, left iliolumbar ligament hypertonicity, mild left psoas spasm and left erector spinae m.
    [Show full text]
  • High Ankle Sprain
    SYNDESMOSIS INJURY (HIGH ANKLE SPRAIN) A syndesmosis injury, also known as a high WHAT ARE THE SYMPTOMS ● Restore joint proprioception ankle sprain, is an injury to the ligaments OF A SYNDESMOSIS and balance at the top of your ankle. These high ankle INJURY? ● Restore normal function ligaments connect your tibia (shin bone) and ● Pain felt above the ankle that increases ● Walking fi bula (outside leg bone) to your calcaneum with outward rotation of the foot ● Running (heel bones), and form part of your ankle. ● Pain with walking and often signifi cant ● Jumping and landing The injury involves the syndesmosis, a bruising and swelling across the higher ● Speed and agility ligament that holds the lower part of your ankle rather than around the malleolus ● Sport-specifi c skills tibia and fi bula together just above your (ankle bones) ● Resume sport. ankle joint. ● Inability to perform a one-legged calf High ankle sprains are much less raise (going up onto your toes) Phase 1 of treatment is focused around common but are more disabling than your ● Feeling of instability/‘no confi dence’ pain relief and reducing infl ammation. traditional lower ankle sprain (when you jumping on the injured leg. This includes the RICE protocol - rest, ice, roll over the outside of your ankle). They compression and elevation. Treatments must be diagnosed early and appropriate The severity of the symptoms will depend may also include electrotherapy, strapping treatment started, which differs from a on the grade of ankle sprain. Patients with and gentle massage after the fi rst 48 hours. traditional ankle sprain, in order to get best a high ankle sprain without fracture may be Phase 2 of treatment, the therapist will results.
    [Show full text]
  • Ankle Fractures
    HughstonHughston HealthHealth AlertAlert 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31908-9517 • www.hughston.com/hha FRACTURES AND YOU Volume 19, Number 2 - Spring 2007 Inside... Fig. 1. Normal anatomy of the ankle • Distal Radius Fractures • Wrist Fracture Therapy Posterior (back) view • Hip Fractures in Young Athletes • Protecting a Fracture Lateral (outside) view • Robert J. McAlindon, MD Tibia Fibula Ankle Fractures Posterior Tibia tibiofibular Fibula Ankle fractures often occur in ligament Anterior athletes who play in pivoting sports Talus tibiofibular ligament such as football, basketball, and soccer. Anterior However, simple movements while Posterior talofibular doing common, everyday activities can talofibular ligament ligament cause ankle fractures. Activities, such as stepping off a curb and turning your ankle, falling off your kitchen stool and twisting your ankle, and falling from a ladder and fracturing the ankle at Deltoid Calcaneus Calcaneofibular impact can cause mild to serious ankle ligament (heel bone) ligament fractures. The ankle is a ginglymus (hinge) joint that connects the foot and leg. If a fracture, or bones and the strength of the ligaments provide excellent break, occurs in any of the 3 bones (tibia, fibula, and talus) joint stability. or if a combination of the 3 bones are cracked, or broken, One of the most important considerations when dealing the injury is considered an ankle fracture. An ankle with ankle fractures is the articular cartilage (covering on fracture can be painful and it can keep you from doing the the ends of bones), or gristle caps. The articular cartilage in things you enjoy, so prompt diagnosis and treatment is the ankle can withstand multiple times a body’s weight necessary.
    [Show full text]
  • Pediatric Ankle Fractures
    CHAPTER 26 PEDIATRIC ANKLE FRACTURES Sofi e Pinney, DPM, MS INTRODUCTION stronger than both the physis and bone. As a result, there is a greater capacity for plastic deformation and less chance of The purpose of this review is to examine the current intra-articular fractures, joint dislocation, and ligamentous literature on pediatric ankle fractures. I will discuss the disruptions. However, ligamentous injury may be more anatomic considerations of a pediatric patient, how to common than originally believed (1). A case-control study evaluate and manage these fractures, and when to surgically by Zonfrillo et al found an association between an increased repair them. Surgical techniques and complications will be risk of athletic injury in obese children, and concluded a briefl y reviewed. higher body mass index risk factor for ankle sprains (4). Ankle fractures are the third most common fractures in Secondary ossifi cation centers are located in the children, after the fi nger and distal radial physeal fracture. epiphysis. The distal tibial ossifi cation center appears at 6-24 Approximately 20-30% of all pediatric fractures are ankle months of age and closes asymmetrically over an 18-month fractures. Most ankle fractures occur at 8-15 years old. The period fi rst central, then medial and posterior, with the peak injury age is 11-12 years, and is relatively uncommon anterolateral portion closing last at 15 and 17 years of age for under the age 5. This injury is more common in boys. females and males, respectively. The distal fi bula ossifi cation The most common cause of pediatric ankle fractures is a center appears at 9-24 months of age and closes 1-2 years rotational force, and is often seen in sports injuries associated after the distal tibial.
    [Show full text]
  • Ankle Fracture Protocol: Operative Treatment
    53880 Carmichael Drive ● South Bend, IN 46635 60160 Bodnar Boulevard ● Mishawaka, IN 46544 Phone 574-247-9441 ● Fax: 574-247-9442 ● www.sbortho.com ANKLE FRACTURE PROTOCOL: OPERATIVE TREATMENT Ankle fractures are common injuries both in young and older patient populations caused by both low energy (trip or fall) and high energy (automobile accident) trauma. Although there are multiple ways of describing ankle fractures and no two fractures are exactly alike, the most important aspect of how we treat your ankle fracture depends on whether the ankle fracture is stable or unstable. The “stability” of the ankle is often determined by whether or not there is an injury to the ankle syndesmosis (the joint between the tibia and fibula). Your treatment plan will be dictated partly by whether or not this is injury which is evaluated intraoperatively at the time of surgery. There are two basic types of ankle fractures: 1) High Energy Axial Injuries: Pilon 2) Rotational Injuries: - Malleolar – either medial or lateral - Bimalleolar – both medial and lateral - Trimalleolar – includes posterior malleolus The goal of treatment is to maximize the long term function of the ankle by restoring and maintaining alignment. If surgery is not required then patients may be treated with closed reduction and immobilization in the form of a splint, cast, pneumatic walker, or air splint. If surgery required then patients may be treated with open reduction and internal fixation. The amount of weightbearing allowed is based on the quality of the fixation, quality of the bone and the healing status of the fracture. If the fixation is secure and stable, the expectation is for the patient to begin early AROM once the wounds are healed ~ two weeks status post.
    [Show full text]
  • Physiotherapy Following Your Ankle Fracture
    Physiotherapy following your ankle fracture This leaflet has been given to you to assist you in returning back to normal following your fractured ankle. If you have any queries after reading it, please discuss with your physiotherapist or contact the physiotherapy department on 0118 322 7812 Monday to Friday 8am to 4pm. What is an ankle fracture? • A fracture is the same as a break. • The broken bone often occurs in just the fibula (the thinner bone on the outside of your lower leg). The break may be below, at the same level or above your ankle joint. These fractures may be referred to as a Weber fracture and are classified as A, B or C dependent on the site of the break (see below). • Occasionally the tibia (the thicker bone in your lower leg may also be involved. Weber fractures of the ankle. How is it treated? • Most fractures will heal themselves but do need a period of protected immobilisation to allow this healing to occur. • Occasionally your ankle may need to be manipulated prior to being immobilised to ensure it heals in the correct position. • Your ankle may be immobilised in a plaster cast or a boot. This usually lasts for up to six weeks but may be shorter or longer depending how well healing occurs. • Occasionally your ankle may require surgery to stabilise the fracture with pins and plates. • While the plaster is on, it is important to keep your toes and knees moving to prevent them becoming stiff. Physiotherapy following your ankle fracture, August 2021 1 Physiotherapy Department / Physiotherapy following your ankle fracture • When your consultant thinks you are ready the plaster cast will be removed and you can then start to move your ankle.
    [Show full text]
  • Ankle Fracture
    NHS Forth Valley Ankle Fracture Patient Information Leaflet Introduction l A fracture is the same as a break. l A simple fracture will be treated in a plaster. l More complicated fractures may be fixed with pins and plates. Bones of the Tibia Foot and Ankle Fibula Navicular Metatarsals Talus Cuneiforms Phalanges Cuboid Calcaneus 2 What should I expect when my plaster is taken off? 1. SKIN CHANGES – dry skin, colour changes and increased hair growth. 2. STIFFNESS – because your ankle has been held in one position by the plaster for a period of time. 3. SWELLING – your foot and ankle will be swollen, this may increase at the end of the day or if you have been upright too long. 4. DISCOMFORT – you may feel more pain as you begin to move and walk on your ankle. This is normal and will ease. The above symptoms can restrict your walking initially. You may require to continue using a stick or crutches. You will be advised on this. 3 What should I do to help these symptoms? 5. ELEVATION – keep your leg elevated when you are not walking. Support your leg with pillows/cushions; make sure your foot is above the level of your hip. Doing your exercises in this position reduces swelling. 6. COMPRESSION – You may have been given tubigrip to use on your ankle/foot during the day. Make sure there are no wrinkles. Take it off at night. 7. DRY SKIN/EXCESSIVE HAIR GROWTH – wash the foot/ankle with warm water. Use a bland moisturiser (aqueous cream) for the first few days.
    [Show full text]
  • Ankle Fractures 3
    Ankle Fracture Update OTA RESIDENT CORE CURRICULUM LECTURE SERIES Christopher Lee, M.D. UCLA Core Curriculum V5 Objectives Following this session, you should be able to: 1. Understand normal versus abnormal radiographic parameters 2. Indications for surgical fixation of ankle fractures 3. Define articular pathology associated with the Lauge-Hansen classification 4. Define common posterior malleolus pathology 5. Indications for posterior malleolus fixation 6. Understand syndesmosis evaluation and treatment principles Core Curriculum V5 Outline • Evaluation: Clinical and Radiographic • Classification: Weber Lauge-Hansen • Specific Problem Areas: Posterior Malleolus and Syndesmosis • Outcome • Diabetic Ankle Fractures Core Curriculum V5 Evaluation: Clinical HISTORY PHYSICAL EXAM • Mechanism • Skin • Timing • Nerves • Soft-tissue Injury • Vasculature • Bony Quality • Pain • Comorbidities • Deformity • Associated Injuries • Instability: Does the ankle easily re-dislocate? Core Curriculum V5 Physical Exam • Look at the soft tissue! • Open versus tenting versus closed Core Curriculum V5 Radiographic Evaluation • Ensure adequate films • Joint above and below • Ankle series (AP/LAT/MORTISE) • Special films • Manual stress • Gravity stress • CT • For specific pathology Core Curriculum V5 AP Ankle • Tib/Fib overlap: ~10 mm • Tib/Fib clear space: <5 mm • End on view of fibula • Can evaluate if screw through fibular plate going into incisura or not Core Curriculum V5 Mortise View • Tib/fib overlap: >1 mm • Talocrural angle: <8 or >15 degrees Core Curriculum
    [Show full text]
  • Residents Comprehensive Fracture Course Faculty: Lunch /Spinesymposium Wednesday - Friday, October 5 - 7
    RESIDENTS COMPREHENSIVE FRACTURE COURSE • Wednesday – Friday, Modules Module One October 5 – 7, 2016 Articular Fractures Module Leaders: Frank A. Liporace, MD Toni M. McLaurin, MD & Marcus F. Sciadini, MD, Timothy S. Achor, MD Program Chairs Topics Distal Humerus Course Description Anatomy/Approaches (incl. Osteotomy) Post-Operative Treatment Reduction and Implant Techniques Total Elbow Arthroplasty The Residents Comprehensive Fracture Course will be presented Elbow in six (6) separate small group modules, with 22 - 24 residents Anatomy and Radiographs Olecranon Fractures and 5 experienced faculty educators per module. Monteggia Fractures Terrible Triad Wednesday - Friday, October 5 - 7 - Friday, Wednesday The modules will have a rapid-fire series of mini-lectures, an Tibial Plateau extensive open case-based discussion, video demonstrations of Fragment Specific Fixation Classification techniques, and hands-on skills lab exercises. Modules will cover Medial/Posteromedial Fragment Lateral Articular Fragment fundamental principles of fracture care distributed among six topics: Treatment Algorithms: Low Energy - High Energy articular, diaphyseal, foot & ankle, geriatrics, pediatrics, and Supracondylar Femur pelvis/polytrauma/acetabulum, plus a lunch-time spine session. ORIF - Intramedullary Nailing Anatomy Implant Position and Surgical Techniques Radiography This course offers pre-course educational on-demand video materials. Details will be sent with registration confirmation as Case-Based Discussions well as an online basic science pre-test and an onsite clinical Intra-articular Distal Humerus Fracture Monteggia Fracture post test. Olecranon Fracture Terrible Triad Residents Comprehensive Fracture Course Fracture Residents Comprehensive Intercondylar Femur Fracture Lateral Plateau Fracture Bicondylar Plateau Fracture B3 Distal Femur Fracture Target Audience Hands-on Skills Labs This course is targeted for PGY2 – PGY4’s, others who feel they Olecranon Tension Banding and Plating Tibial Plateau will benefit will not be excluded.
    [Show full text]
  • Sports Injuries of the Foot and Ankle
    Sports Injuries of the Foot and Ankle Dr. Travis Kieckbusch August 7, 2014 Foot and Ankle Injuries in Athletes • Lateral ankle sprains • Syndesmosis sprains “high ankle sprain” • Achilles tendon injuries • Lisfranc injuries • Fifth metatarsal fractures • Plantar plate injury Foot and Ankle Injuries in Athletes • Lateral ankle sprains • Syndesmosis sprains “high ankle sprain” • Achilles tendon injuries • Lisfranc injuries • Fifth metatarsal fractures • Plantar plate injury Lateral Ankle Sprains • Most common injury in sports • Mechanism of injury is inversion • Injury to ATFL and CFL most commonly • Lateral ankle ligaments • Deltoid (medial)involved in more severe cases • Significant variability in severity Ankle Ligaments Lateral Ankle Sprains • Most common injury in sports1 Lateral Ankle Sprains • Physical exam • Swelling and ecchymosis laterally • Possibly medially as well • Limited motion • Tenderness over ATFL, CFL • Variable ability to bear weight Ottawa Ankle Rules Lateral Ankle Sprains • Treatment • Most treated non-operatively • Brace/splint until pain tolerable • Edema control • Most important is rehabilitation including proprioception • Most common cause of recurrent sprain is failure to rehab correctly Lateral Ankle Sprains • Treatment • Operative treatment for chronic instability following injury • No indication for acute surgery • Beware of lateral process talar fracture in lateral ankle sprain that won’t resolve Lateral Ankle Sprains • Treatment • Operative treatment for chronic instability following injury Lateral Ankle
    [Show full text]
  • Implement Evidence-Based Strategies in the Care of Patients Who Sustain
    Conflict of Interest Care of the Patient with an I hereby certify that, to the best of my knowledge, no aspect of my current Orthopaedic Sports Injury personal or professional situation might reasonably be expected to affect significantly my views on the subject on Bryan Combs, MSN, FNP‐BC, CNL, ATC which I am presenting other than the following: Learner Outcome Sports Medicine • Sports medicine, also known as sport and Implement evidence‐based exercise medicine, is a branch of medicine strategies in the care of that deals with physical fitness and the treatment and prevention of injuries related patients who sustain sports to sports and exercise related injuries 1 The Sports Medicine Team The Sports Medicine Team Athlete Athlete Athletic Athletic Trainer Trainer NP/Doctor Coach NP/Doctor Coach Understand the Setting Understand the Sport • The Sideline • They each have specific aspects that you must know • The Training Room – Required equipment • The Office – Contact vs Non‐Contact – How far apart are games • This is critical for planning care 2 What Are the Expectations Return To Play: Risk vs Reward • This is a difficult balance • What is the typical treatment plan? • There can be a lot of voices • What is the goal of the athlete? – Athlete, Coach, Parents, etc. • Are they hurt or are they injured? • Must keep the health of the patient as the • Can they make the injury worse? primary goal • Can they be protected? • Risk vs Reward • Where are they in the season and what is their unique situation? Not the Typical Pharmacology The Basics – H.O.P.E.
    [Show full text]
  • Closed Reduction, Traction, and Casting Techniques
    Closed Reduction, Traction, and Casting Techniques Jason Tank, MD March 2014 Original Authors: Dan Horwitz, MD; March 2004; David Hak, MD; Revised January 2006 & October 2008 New Author: Jason Tank, MD Contents • Closed Reduction Principles & Anesthesia options • Splinting Principles • Common Closed Reductions • Casting Principles – Complications • Traction Principles – Complications – Halo Application Closed Reduction Principles • Identify need for closed reduction – Most displaced fractures should be reduced to minimize soft tissue complications & injury • Includes injuries ultimately treated with surgery • Various resources for acceptable non-operative fracture alignment parameters – Find & utilize a reliable source Closed Reduction Principles • Prior to reduction – H&P • Define injury & host factors – Trauma ABC’s first • Evaluate skin, compartments & neurovascular status – Urgent/Emergent reduction » Dysvascular distal limb, significant skin tenting • Organize/customize appropriate team for: – Sedation need – Reduction & immobilization assistance – Post reduction imaging Closed Reduction Principles • Reduction maneuver specific for fracture location & pattern • Goals: – Restore length, alignment & rotation • Immobilize joint above & below • Quality post reduction radiographs Anesthesia • Adequate analgesia & muscle relaxation/fatigue are critical for success • Determine goals of reduction & plan • Customize anesthesia for each patient & injury combination Anesthesia Options IV Sedation Pros • Versed: 0.5-1 mg q 3 min (5mg max) Potential
    [Show full text]