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foot and ankle Flashcards

(60 cards)

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1
Q

True foot and ankle emergencies (5)

A 
Open fractures (OR right away)
Check for pulses first!!!
Compartment syndrome/crush injury
Ischemic foot
Infection (blisters = bad)
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2
Q

red flags of foot injury

A 
edema-compare 
ecchymosis -mondor
Point Tenderness
Obvious deformity
Gait abnormality
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3
Q

mondor

A

– sign of calcaneal fx (look at the sole of the foot)

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4
Q

approach to erythema as a rf

A

Whiteness with erythema around – no vascular supply present, huge crater underneath present
Looking for streaking/lymphangitis – infection going up lymph chain (signals a much worse infxn)
Draw a line around the cellulitis – if the redness crosses the blue line, then come back right away for IV abx

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5
Q

High tib-fib squeeze

checks for

A

Syndesmotic injury – looking for maisoneuve fx

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6
Q

Ankle external rotation test allows for evaluation of

A

Syndesmotic injury

Move their foot to the side

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7
Q

Anterior drawers, talar tilt

helps evaluate what

A

ATFL or CFL injury

Stabilize lower leg with hand on top; grab the calcaneus and move the foot forward and back

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8
Q

stress foot abduction tests looks for

A

Lisfranc fracture dislocation

Move the toes and the forefoot to see if there is movement of the mid foot

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9
Q

other than MSK what other systems would you want to evaluate

A

NEURO-gross and distal
VASC DERM -DP and PT pulses; if you cant feel them- Doppler them!

DERM- Open wounds or other red flags

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10
Q

ankle rules xray

A

need to be non tender over the malleolus

weight bearing for at least three steps

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11
Q

foot rules xray

A

any tenderness in the mid foot

base of metatarsal or navicular bone

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12
Q

three views of the foot

A

AP, Lateral, and oblique views

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13
Q

three views of the ankle

A

AP, Lateral, and Mortise views

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14
Q

if problem with proximal leg get this xray

A

Calcaneal axial, high tibia/fibula (if problem with proximal leg)

suspect Calcaneal fracture

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15
Q

weber classification

A

describes destruction of syndysmosis in ankle fractures

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16
Q

weber A

A

most distal

below syndesmosis

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17
Q

weber B

A

level of syndesmosis

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18
Q

weber V

A

above level of syndesmosis

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19
Q

special view of joint that helps evaluate syndesmosis

A

stress view

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20
Q

preferred treatment for non-displaced stable fracture of the ankle (isolated malleolar)

A

Non-displaced, stable
Posterior splint, Jones, NWB
F/u 5 – 7 days

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21
Q

three types of ankle fractures

A

isolated
bimalleolar
trimalleolar

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22
Q

jones compression dressing

A

splint for ankle fracture

the idea is that you want to reduce the swelling

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23
Q

jones fractures concerns

A

not a lot of blood flow so they need to be splinted and NWB VS Dancers with is an avulsion

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24
Q

trimal MOA

A

severe force from underneath or twisting

bony ligamentous ring is completely disrupted and a cradle needs to be formed to keep the NVS intact

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25
post traumatic ankle pain causes
Watch for Chronic Post-Traumatic Ankle Pain Osteochondral fracture of talus CRPS (Complex regional pain syndrome) Occult fracture
26
MOI for calcaneal fracture what is the imaging study of choice
fall from a height Imaging- NWB plain films B/L feet; *Then if fx- CT with 3D recon is preferable
27
if pt has a calcaneal fx what else do you worry about? what do you ask any traumatic pt
Also worry about lumbar spine and the other foot NECK PAIN BACK PAIN CP ABD PAIN?
28
management of calcaneal fx
NWB Jones compression splint If fracture blisters occur, use oil emulsion dressing to cover Usually delay in ORIF of 1-2 weeks while edema and skin issues resolve
29
talar fx MOI
High energy | MVA or fall
30
talus tx
NWB DO NOT attempt to reduce Call for consultant Treated as emergency due to high rate of AVN ORIF vs casting and immobilization Can be prolonged course for healing >12 weeks
31
MOI of lisfranc
FORCED Dorsifelxion MVA fall from height equestrian injury CAN OCCUR WITHOUT FX but the pt will be unable to bear weigh t
32
xray for suspected lisafranc
NWB AP and Medial Oblique radiographs; WB and stress abduction films if old
33
pts with suspected lisfranc need to monitor for what?
Monitor for signs of vascular injury and compartment syndrome Check for malalignment at met-cuneiform articulation
34
after establishing lisfranc what should you do?
Call consultant- do not attempt to reduce; it is reduced in the OR Neuro checks in ED If stable, Jones splint
35
Fractures with high potential for bad outcomes**********
Open fractures Calcaneal fractures Talar neck fractures Lisfranc fractures Non-reducible fractures N O lisa tala him to cal
36
fracture complications
Non/Mal union (jones fx) Compartment syndrome Complex regional pain syndrome
37
what do you see with CRPS
Hyperalgesia mechanical thermal allodynia Sudomotor changes Often occurs secondary to ankle injury! (manage with PT)
38
OCD in talus (Osteochondral defect of the talus)
can occur during surgery or during the injury Usually result of impact or mal-reduction during fracture or ORIF Needs a podiatrist Won’t be able to walk Easy to miss
39
thermal allodynia
can lead to the triggering of a pain response from stimuli which do not normally provoke pain.
40
who do we see ATR in
Common injury in men >45 yrs old | “Weekend warriors”
41
presentation
Feel a ”pop” or like someone hit them with a bat in the back of the leg Focal pain and inability to bear weight on affected limb Thompson-Dougherty Test-Positive (if foot doesn’t move when calf is squeezed)= rupture Negative= intact
42
imaging if thompson's test is weird
ULS MRI Helpful if Thompson test is questionable Also useful if neglected rupture
43
treamtent of achilles tendon tx
We splint the patient in equinus (pointed toe – allows your achilles to find itself) plantar fracture
44
untidy vs infected
Untidy Wounds with tissue loss Infected wounds > 8 hours old
45
mnmgt of foot fractures
Obtain at least two radiographic views 90° apart Check for associated fracture/dislocation Attempt closed reduction
46
picture of less complex fractures
still hurt a fuck ton Distal to metatarsal neck Closed Non to slightly displaced Single Usually treatable with taping and post op shoe buddy tape! +post op shoe
47
complex fractures of the foot
proximal to met neck Involves tendon or ligament avulsion – they have to restabilize the tendinous or ligamentous connection
48
tx of complex foot fractures
Multiple Needs additional imaging Can lead to poor outcome, even if treatment is ideal May require ORIF and prolonged follow up
49
how determine if a fx is open or not
look for continued oozing to determine is this open or nah "no oozing since they arrived --> probably not open" fat molecules in the blood--> might be open "there is a small 1cm wound just medial to the fx, not oozing, appears superficial with some concern for open fracture"
50
open fx treatment
Treat all open fractures as an emergency Evaluate the patient for other injuries Start appropriate antibiotic therapy (ANCEF) Tetanus prophylaxis Do an adequate (in OR) debridement and irrigation Dry blood on a wound carries infxn Stabilize the fracture (with towels, blankets, or splint until the consultant arrives) Arrange appropriate wound coverage Start early rehabilitation
51
easy explanation for compartment syndrome
Bleeding into a compartment may lead to elevated intracompartmental pressures blood supply going into a muscle that is considered excess might disrupt the "ziplock bag" at risk for muscle death IV hydration is needed to avoid rhabdomyolosis
52
other than necrosis what are the complications of compartment syndrome
Permanent nerve and muscle loss Rhabdomyolysis – CK is elevated Get renal failure and can be fatal Necrosis leading to amputation
53
Charcot foot -what is it
Neuro-arthropathy – a relatively painless, progressive, destructive arthropathy seen with distinct erosion of the bone
54
Charcot foot -tx
Will mimic infection in presentation Red hot swollen foot Usually totally neuropathic “it doesn’t hurt” Get plain films – will see joint destruction Workup for infection Basic labs- CBC, sed rate, CRP, culture wounds if appropriate Associated plantar wounds- usually source of infection if present
55
diabetic foot ulcer
``` Polymicrobial Poor compliance and glycemic control Neuropathy Hemodynamically stable? If grey → no vascular supply ```
56
criteria for sepsis
Sepsis. Meeting SIRS Criteria?
57
workup for foot ulcer
Basic labs- CBC, CMP, sed rate, CRP Plain films; CT helpful to eval for gas (probe to bone is osteomyelitis ) Call for consultant and admission To OR for I&D or more…
58
treatment of foot ulcer
Fluids, fluids, fluids abx NPO (please?) Dressings Usually gauze to cover until we get there To OR for debridement Cultures intra-op Will require wound care for prolonged period
59
what needs to be on the foot and ankle ROS
foot pain swelling coughing up blood? CHEST PAIN document this shit to rule out DVT
60
ruling out septic joint
full ROM

Emergency Medicine (28 decks)

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