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Fractures,Sprains, and Soft Tissue Disorders

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Presentation on theme: "Fractures,Sprains, and Soft Tissue Disorders"— Presentation transcript:

1 Fractures,Sprains, and Soft Tissue Disorders
Foot and Ankle Fractures,Sprains, and Soft Tissue Disorders

2 Ankle Sprain 25,000 people sprain an ankle every day
85% of the time lateral collateral ligaments injured (anterior talofibular and calcaneofibular) Inversion injury 5% syndesmosis injury symptoms: pain, swelling, loss of function Treatmentis aimed at preventing chronic pain and instability NSAIDS, ice, compression, elevation Air stirrup, WBAT, and physical therapy Should improve in 6 weeks

3 Ankle Fractures Fractures involve the medial or lateral malleolus, the posterior lip of the tibia, the collateral liagamentous structures, or the talar dome Stable fractures= one malleolus , no ligaments Unstable fractures= both malleoli or a distal fibula and disruption of the deltoid ligament Unstable fractures= vulnerable for displacement, instability, and posttraumatic arthritis

4 Symptoms: pain, swelling, tenderness, deformity
Examination: include evaluation of the posterior tibial pulse and posterior tibial nerve (plantar sensation) X-rays: AP, lateral, oblique (mortise view) Cat Scan for complex fractures with articualr surface involvement or lateral portion of the distal tibia

5 Treatment: Stable unimalleolar fxs= WB SLC Unstable fractures= ORIF

6 Maisonneuve Fracture Fracture of the proximal fibula with torn medial deltoid ligament, and disruption of the ankle mortise Palpate proximal fibular with all medial ankle pain presentations Treatment= ORIF

7 Fractures of the Hindfoot
Talus fracture: usually result of severe trauma Calcaneus fracture: MVA or fall from a height Sx: tenderness over talonavicular joint anterior to the medial malleolus, tenderness with side to side compression of the heel, swelling in the heel & ankle, and the inability to weight bear Tx: ORIF * watch for plantar compartment syndrome* Talus fx: can lead to osteonecrosis

8 Fracture of the Metatarsal
Jones’ Fracture: proximal metaphysis of the fifth metatarsal propensity for non or delayed union NWBC 6 weeks, folllowed by WB cast until healing occurs Base of the Fifth Metatarsal Fracture: inversion injury R/O with suspicion of ankle fracture Most respond to closed reduction

9 Fracture of the Midfoot
Lisfranc Fracture-Dislocation Critical injury to the second tarsometatarsal joint=stabilizing apex for the other tarsometatarsal joints since it “keys” into a slot in the cuneiforms *Easily missed and misdiagnosed as an ankle sprain*

10 Exam Careful examination will reveal area of maximum tenderness over the tarsometatarsal joint Stabilize the calcaneus and rotate and/or adduct the forefoot=severe pain X-rays AP, laterl, oblique views of the foot, standing if possible Common error is to obtain only ankle films Normal alignment=medial aspect of the middle cuneiform with the medial aspect of the second metatarsal base Stress views , CT, MRI

11 Treatment Significant swelling occurs-elevate and ice
Beware of Compartment Syndrome Nondisplaced injuries=NWBC Displaced=ORIF

12 Morton’s Neuroma Fibrosis of the common digital nerve as it passes between the metatarsal heads *commonly between the third and fourth toes* Sx: plantar pain, numbness, and “walking on a marble” * firmly squeeze metatarsal heads with one hand while applying direct pressure to the interspace with the other Tx: metatarsal bar, injection, surgical excision

13 Plantar Fasciitis Plantar heel pain that occurs where the plantar fascia arises from the medial calcaneal tuberosity Sxs: focal pain often increased upon awakening or when rising from a resting postion Tx: 95% conservative treatment Achilles & plantar fascia stretching, night splints, NSAIDs, injection

14 Achilles Tendinitis & Rupture
Rupture: sudden, severe calf pain described as a gunshot wound or direct hit Middle-aged men = weekend athletes Swelling and ecchymosis from the calf to heel Weakness with push-off + Thompson test=absence of plantar flexion with calf compression

15 Tendinitis: insertional or 4-5 cm proximal
Insidious pain that increases with exercise Often after a change in training habits Protuberant posterolateral bony proces of the calcaneus Treat conservatively

16 Shin Splints Chronic leg Pain- palpation of the tibial crest will usually identify a pinpoint spot Compression of the tibia and fibula will result in pain at the fracture site Tx: reduction in athletic activity 4-6 wks NSAIDs Removable cast for ambulation Progressive training shedule: no more than 10% week

17 Diabetic Foot: Charcot Foot
Insensate foot fails to provide sensory feedback, causing the skin to break down due to unperceived repetitive trauma 3 major clinical problems=diabetic ulceration, deep infection, and Charcot joints Sxs: hot, red, swollen with intact skin Elevate foot 5 mins=Charcot will lose redness

18 Evaluation must include checking for cellulitis, osteomyelitis, and gout
X-rays Vascular studies if pulses are absent or a nonhealing ulcer is present There is no noninvasive study that differentiates Charcot xray changes from osteomyelitis: GENERALLY- osteomyelitis will develop only if the skin has been violated

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