Surgery → infection, phlebitis, pulmonary emboli, neurovascular insult, scarring, possibility of re-tear, failure of ACL graft to incorporate, excessive laxity
What are referral decisions and red flags in ACL injuries?
Post-traumatic knee effusions
Suspected ACL tears
What are symptoms of an ankle fracture?
Palpable gap on medial side
External rotation or lateral displacement of foot from tibia
What is a bimalleolar fracture? Describe what is presumed to be a bimalleolar fracture.
Bimalleolar is when both medial and lateral malleolus are fractured
Fracture of distal fibula (lateral malleolus) with tenderness over medial deltoid ligament is presumed to be an unstable bimalleolar injury
What is a Maisonneuve fracture?
How do you check for it?
Fracture of proximal fibula
Tenderness in proximal fibula and swelling of medial ankle
Unstable external rotation injury that includes fracture of the proximal fibula, tear of medial deltoid ligament, disruption of tibiofibular syndesmotic ligaments
How do you diagnose an ankle fracture?
X-rays: AP, lateral, mortise (AP view with ankle internally rotated 15 degrees); also AP/lateral of proximal fibula and tibia when tenderness there; minimally displaced fractures not evident on initial x-rays; must repeat in 10 to 14 days
What happens to the medial clear space (MCS) in the mortise view with a lateral fibular fracture with deltoid disruption?
MCS widens to beyond 5mm
What fracture can happen to the talus?
Osteochondral fracture of the lateral articular surface (best seen on mortise view)
How do you treat ankle fractures?
Stable fractures of distal fibula → Weight-bearing case for 4 to 6 weeks
Unstable, non-displaced fractures → Non-weight-bearing short or long leg cast
Unstable, displaced fractures → Closed or open reduction
What do you do with osteochondral fragments of the talus?
Remove them, unless it's a young person then you can try to screw them back
What are referral decisions and red flags in ankle fractures?