0071643192.pdf

ORTHOPEDICS

TREATMENT

Apply posterior splint in plantar flexion and orthopedic consult. Early surgical

repair leads to a better outcome.

COMPLICATIONS

Twenty-five percent are initially misdiagnosed as ankle sprains

PERONEALTENDONSUBLUXATION/DISLOCATION

Most often associated with skiing injuries

MECHANISM

Forced dorsiflexion with peroneal muscle contraction

DIAGNOSIS

There is swelling posteriorly over lateral malleolus in absence oftenderness

over anterior talofibular ligament; often mistaken for ankle sprains!

On exam with foot dorsiflexed and everted, there is anterior tendon subluxa-

tion. Fifty percent have a small avulsion fracture of lateral ridge of distal fibula.

TREATMENT

Splint in midplantar flexion, orthopedic referral for possible surgical repair

MAISONNEUVEFRACTURE

Ankle-eversion injury with forces causing disruption of the tibiofibular

syndesmosis

DIAGNOSIS

Rupture of the deltoid ligament or avulsion fracture of medial malleolus,

along with fracture of the proximal fibula

TREATMENT

Often requires ORIF to stabilize the tibiofibular syndesmosis

Foot Injuries

CALCANEUSFRACTURE

Most commonly fractured tarsal bone

MECHANISM

Usually severe axial load caused by a fall from a significant height

DIAGNOSIS

Bohler’s angle <20° (angle between a line formed from the posterior tuberosity

of the calcaneus and the apex of the posterior facet and a line between the

Ottawa ankle and midfoot

Rules

Get ankle films if there is

malleolar pain and any of the

following:

1. Tenderness on the posterior
   edge, tip, or distal 6 cm of
   lateral or medial malleolus


2. Inability to complete four
   steps (or two steps on bad
   ankle), now and at the
   scene of the injury
   Get foot films as well if
   midfoot pain and any of the
   following:


3. Navicular tenderness


4. Base of fifth metatarsal
   tenderness


5. Inability to complete four
   steps