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Flashcards in foot and ankle Deck (60)
1

True foot and ankle emergencies (5)

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

2

red flags of foot injury

edema-compare
ecchymosis -mondor
Point Tenderness
Obvious deformity
Gait abnormality

3

mondor

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

4

approach to erythema as a rf

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

5

High tib-fib squeeze
checks for

Syndesmotic injury – looking for maisoneuve fx

6

Ankle external rotation test allows for evaluation of

Syndesmotic injury
Move their foot to the side

7

Anterior drawers, talar tilt
helps evaluate what

ATFL or CFL injury

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

8

stress foot abduction tests looks for

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

9

other than MSK what other systems would you want to evaluate

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

DERM- Open wounds or other red flags

10

ankle rules xray

need to be non tender over the malleolus

weight bearing for at least three steps

11

foot rules xray

any tenderness in the mid foot

base of metatarsal or navicular bone

12

three views of the foot

AP, Lateral, and oblique views

13

three views of the ankle

AP, Lateral, and Mortise views

14

if problem with proximal leg get this xray

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


suspect Calcaneal fracture

15

weber classification

describes destruction of syndysmosis in ankle fractures

16

weber A

most distal
below syndesmosis

17

weber B

level of syndesmosis

18

weber V

above level of syndesmosis

19

special view of joint that helps evaluate syndesmosis

stress view

20

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

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

21

three types of ankle fractures

isolated
bimalleolar
trimalleolar

22

jones compression dressing

splint for ankle fracture

the idea is that you want to reduce the swelling

23

jones fractures concerns

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

24

trimal MOA

severe force from underneath or twisting

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

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