Pilon And Ankle Fractures

Front 1

Most commonly missed injuries associated with ankle fractures

Back 1

Achilles tendon rupture
lateral process of the talus fractures
metatarsal fractures
anterior process of the calcaneus fractures

Front 2

physical exam for ankle

Back 2

skin (edema, blisters, tenting, open wounds)
pulses (DP/PT)
sensation (superficial peroneal = dorsum except 1st web space, saphenous = medial ankle)
ROM

Front 3

squeeze test

Back 3

squeeze fibula and tibia in proximal calf
pain = syndesmotic disruption
diagnostic for syndesmosis injury

Front 4

Thompson test

Back 4

compression of gastrocnemius muscle and assess for plantar flexion of foot, failure = ruptured Achilles

Front 5

anterior drawer test of the ankle

Back 5

stabilize tibia while cupping posterior calcaneus and imparting anterior translational force
laxity = ant talofibular lig injury

Front 6

ankle ROM

Back 6

dorsiflexion = 15-18
plantarflexion = 39-48
inversion = 27-33
eversion = 18-27

Front 7

Ottawa ankle rules

Back 7

determines when should obtain xrays to eval ankle injury
- age >55 yr
- inability to bear weight
- bone tenderness over post edge or tip of either mal

Front 8

initial evaluation of ankle films

Back 8

tibiotalar articulation
assess for fibular shortening
widening of joint space
malrotation of fibula
talar tilt

Front 9

parameters that suggest unstable fracture patterns

Back 9

lat mal displacement >2mm with talar shift on AP or lat
significant med mal displacement
deltoid lig disruption (>5 mm clear space)
syndesmotic injury (>5 mm tib-fib clear space, <10 mm tib-fib overlap AP or <1 mm on mort)

Front 10

talocrural angle

Back 10

measured between a line perpendicular to tibial plafond and a line connecting the tips of the med and lat mals

Front 11

accurate stress test

Back 11

stress in dorsiflexion and external rotation

Front 12

theory of Lauge Hansen classification

Back 12

first part describes position of foot at time of injury
second part describes direction of force applied to foot

Front 13

medial mal shear fracture

Back 13

SA2 - lateral side may be purely ligamentous

Front 14

ATFL origin and insertion

Back 14

fib origin = Wagstaffe tubercle
tib insertion = Chaput tubercle

Front 15

ways to distinguish SER2 from SER4

Back 15

stress view
ant/post subluxation of talus
>2mm shortening of fibula
mild lateral subluxation without stress

Front 16

why is it important to distinguish SER2 from SER4

Back 16

SER2 have shown to have good outcome with nonoperative treatment despite mild talar subluxation on stress views

Front 17

ankle fracture most commonly associated with syndesmotic injury

Back 17

PER

Front 18

MMOLC

Back 18

medial malleolus osteoligamentous complex:
medial mal (ant/post colliculli, intercollicular groove)
superficial/deep deltoid lig
insertions of deltoid

Front 19

origin of superficial deltoid

Back 19

anterior colliculus of medial mal

Front 20

origin of deep deltoid

Back 20

posterior colliculus of medial mal

Front 21

insertions of deltoid lig

Back 21

medial tubercle of the talus
navicular tuberosity
sustentaculum tali

Front 22

three components of superficial deltoid

Back 22

ant: naviculotibial (inserts dorsomedial navicular)
mid: calcaneotibial (inserts sustentaculum tali)
post: superficial talotibial (inserts medial talar tubercle)

Front 23

strongest portion of superficial deltoid

Back 23

calcaneotibial

Front 24

two structures of deep deltoid

Back 24

deep anterior talotibial ligament
deep posterior talotibial ligament

Front 25

origin and insertion of deep anterior talotibial ligament

Back 25

origin = intercollicular groove (deep to calcaneotibial)
insert = medial talus

Front 26

origin and insertion of deep posterior talotibial ligament

Back 26

origin = intraarticular aspect of posterior colliculus
insert = medial talus

Front 27

strongest and thickest ligament of deltoid complex

Back 27

deep posterior talotibial

Front 28

responsible for indirect reduction of posterior mal

Back 28

posterior tibiofibular ligament
pulls back to position when fibula brought back out to length

Front 29

4 components of syndesmosis

Back 29

AITFL (Chaput --> Wagstaffe)
PITFL (Volkman --> post/lat fibula)
inferior transverse tib-fib lig (ITL)
tib-fib IO membrane

Front 30

3 LCLs of ankle

Back 30

ATFL (ant tib-fib lig)
PTFL (post talofib lig)
CFL (calcaneofib lig)

Front 31

strongest of ankle LCL

Back 31

PTFL

Front 32

four tendon groups that cross the ankle joint

Back 32

posterior
medial
anterior
lateral

Front 33

medial ankle tendon group

Back 33

tibialis posterior
flexor digitorum longus
flexor hallucis longus

Front 34

path of medial ankle tendon group

Back 34

under lacinate lig (roof of tarsal tunnel)

Front 35

lateral ankle tendon group

Back 35

peroneus longus
peroneus brevis

Front 36

path of lateral ankle tendon group

Back 36

under the superior peroneal retinaculum posterior to the fibula

Front 37

path of anterior ankle tendon group

Back 37

under extensor retinaculum proximal to ankle and under Y-shaped inferior extensor retinaculum just distal to ankle joint

Front 38

location of saphenous vein and nerve

Back 38

medial - superior to medial mal and lacinate lig

Front 39

path of posterior tibial artery and tibial nerve

Back 39

medial in tarsal tunnel under lacinate lig

Front 40

location of sural nerve

Back 40

lateral - halfway between lateral border of Achilles and posterior border of lateral mal

Front 41

anterior ankle tendon group

Back 41

extensor hallucis longus
extensor digitorum longus

Front 42

contents of anterior ankle

Back 42

deep peroneal nerve
anterior tibial arteries

Front 43

pilon fractures

Back 43

ankle fractures that involve the weight-bearing portion of the distal tibial articular surface

Front 44

cause of substantial swelling and blistering in pilon fractures

Back 44

bone is viscoelastic so more energy is absorbed prior to failure - which is then released and imparted to soft tissue envelope

Front 45

methods to treat fracture blisters

Back 45

sterile unroofing with silvadene and nonadherents
sterile aspiration with maintenance of roof
leaving blister intact

Front 46

hemorrhagic fracture blister

Back 46

dermis is free of epidermal cells --> deeper injury

Front 47

Reudi-Allgower system for pilon fractures

Back 47

I: intraarticular without displacement
II: displaced articular frags without comminution
III: displacement and comminution

Front 48

AO/OTA pilon classification

Back 48

A: extra-articular
B: partial articular
C: complete articular
(subdivisions for increasing amounts of comminution)

Front 49

Tscherne and Goetzne soft tissue injury classification system

Back 49

0 = closed, no appreciable soft tissue injury, indirect simple fracture
1 = superficial abrasion or skin contusion, displaced fracture frags exerting pressure on skin
2 = deep abrasions and local contused skin, imminent compartment syndrome
3 = extensive contusions or crushing, significant muscle destruction and subq tissue degloving, comp syn, vasc injuries, severe fx comminution

Front 50

anterior tibial compartment (med to lat)

Back 50

tibialis anterior
extensor hallucis longus
extensor digitorum longus
peroneus tertius
(innervated by deep peroneal)

Front 51

lateral tibial compartment

Back 51

peroneus longus
peroneus brevis
(innervated by superficial peroneal)

Front 52

superficial posterior tibial compartment

Back 52

gastrocnemius
soleus
plantaris
(innervated by tibial)

Front 53

deep posterior tibial compartment

Back 53

posterior tibial
flexor digitorum longus
flexor hallucis longus
(innervated by tibial)

Front 54

contents of tarsal tunnel

Back 54

tibialis posterior
flexor digitorum longus
posterior tibial artery
tibial nerve
flexor hallucis longus

Front 55

three commonly observed pilon fracture segments

Back 55

medial malleolar fragment
anterolateral (Chaput) fragment
posterolateral (Volkmann) fragment

Front 56

AP radiographic eval

Back 56

tib-fib overlap <10 mm = syndesmotic injury
tib-fib clear space >5 mm = syndesmotic injury
talar tilt (diff in med/lat aspects of superior joint space >2 mm) = medial or lateral disruption

Front 57

mortise radiographic eval

Back 57

medial clear space >4-5 mm = lateral talar tilt
talocrural angle within 2-3 degrees of uninjured
tib-fib overlap <1 mm = syndesmotic injury
talar shift >1 mm is abnormal

Front 58

Maisonneuve fracture

Back 58

proximal third fibular fracture, PER variant

Front 59

curbstone fracture

Back 59

avulsion fracture off posterior tibia - produced by tripping

Front 60

LeForte-Wagstaffe fracture

Back 60

anterior fibular tubercle avulsion fracture
assoc with SER type

Front 61

Tillaux-Chaput fracture

Back 61

avulsion of ant tib margin by ant tib-fib lig
tib counterpart of LeForte-Wagstaffe

Front 62

Mast classification of pilon fractures

Back 62

A: malleolar fractures with sig post lip involvement
B: spiral fx of distal tib with extension into articular surface
C: central impaction injuries

Front 63

Ruedi and Allgower classification of pilon fractures

Back 63

1: nondisplaced cleavage fracture of ankle joint
2: displaced fracture with minimal impaction or comminution
3: displaced fracture with significant articular comminution and metaphyseal impaction

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