ankle fracture and sprains - sam_503503

[ArchivalUser]

can somebody tell me about the guidelines on diagnosis and t/t of sprains and fracture

[ArchivalUser]

Indications for Ankle XRAY: "Ottawa Ankle Rules"
Test Sensitivity for Malleolar Fracture: 95%
Requires alert adult
Injury within prior 10 days
Ankle XRay not needed if both are true:
Able to ambulate at injury or in ER for 4 steps
No pain over distal posterior 6 cm of tibia, fibula.
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Foot Xray not needed for mid-Foot Pain if both true:
No pain at fifth metatarsal base and tarsal navicular
Able to ambulate at injury or in ER for 4 steps.
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Pitfalls
Growth Plate Fracture in adolescent
May be missed on ankle XRay
Consider if pain over lateral malleolus (fibula)
Ankle Syndesmotic Sprain (High Ankle Sprain)
Tibiofibular clear space widening >6 mm.

[ArchivalUser]

Treatment of ankle sprain:
First 1-2 days: RICE- rest, ice (avoid heat, crutch walking for 2 to 3 days), compression (Air cast splint, Air cast splint preferred over Soft Compression Dressing)
Start early range of motion as soon as possible
NSAIDS
No benefit with Therapeutic Ultrasound

After: Days 3-5: Weight Bearing as tolerated, Early Active range of motion

If severe pain after 1 week: Short Leg Walking Cast for 4 weeks

[ArchivalUser]

thanks meshi

[ArchivalUser]

This was for lateral ankle sprain (most common):
Now High ankle sprain-10% of ankle sprains, important to know:
More disabling than other Ankle Sprains
Risk of ankle Degenerative Joint Disease.
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Mechanism :Eversion and Rotation injury and Hyper-dorsiflexion .
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Anatomy: Tibiofibular Syndesmosis injury, Interosseous membrane (IM), Anterior Inferior tibiofibular ligament (AITF), Separation of Tibia from fibula
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Symptoms
Medial ankle pain
Difficulty bearing weight
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Signs
Minimal external signs of injury (e.g. swelling)
Pain and Disability out of proportion with injury
Ankle may feel spongy
Ankle Squeeze Test positive
Ankle External Rotation Test positive
Crossed-Leg Test positive
Point tenderness over anterior and proximal ankle
Pain at distal tibiofibular joint
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Imaging
Ankle XRay
Tibiofibular clear space widening >6 mm
Ankle MRI
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Management
No early mobilization
May require internal fixation

[ArchivalUser]

sorry for the long answer ( i hate it), but this was the long question. and I even did not touch the ankle fractures

[ArchivalUser]

thanks.big help.any ligament tear have to be surgically repaired or not

[ArchivalUser]

I think- no one immediately. correct me if I am wrong