We dissect one of the most common injuries we see in the ER -- ankle sprains
Hosts:
Brian Gilberti, MD
Audrey Bree Tse, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Ankle_Sprains.mp3
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Tags: Orthopedics
Show Notes
Background
* Among most common injuries evaluated in ED
* A sprain is an injury to 1 or more ligaments about the ankle joint
* Highest rate among teenagers and young adults
* Higher incidence among women than men
* Almost a half are sustained during sports
* Greatest risk factor is a history of prior ankle sprain
Anatomy
* Bone: Distal tibia and fibula over the talus → constitutes the ankle mortise
* Aside from malleoli, ligament complexes hold joint together
* Medial deltoid ligament
* Lateral ligament complex
* Anterior talofibular ligament
* Most commonly injured
* Weakest
* 85% of all ankle sprains
* Posterior talofibular ligament
* Calcaneofibular ligament
* Syndesmosis
Mechanism of Injury
* Lateral ankle sprains
* Most common among athletes
* ATFL most commonly injured
* Combined with CFL in 20% of injuries
* 2/2 inversion injuries
* Medial ankle sprains
* Less common than lateral because ligaments stronger and mechanism less frequent
* More likely to suffer avulsion fracture of medial malleolus than injure medial ligament
* 2/2 eversion +/- forced external rotation
* Typically landing on pronated foot -> external rotation
* High Ankle sprains
* Syndesmotic injury
* More common in collision sports (football, soccer, etc)
* Grade I
* Mild
* Stretch without “macroscopic” tearing
* Minimal swelling / tenderness
* No instability
* No disability associated with injury
* Grade II
* Moderate
* Partial tear of ligament
* Moderate swelling / tenderness
* Some instability and loss of ROM
* Difficulty ambulating / bearing weight
* Grade III
* Severe
* Complete rupture of ligaments
* Extensive swelling / ecchymosis / tenderness
* Mechanical instability on exam
* Inability to bear weight
Examination
* Beyond visual inspection for swelling, ecchymoses, abrasions, or lacerations
* Palpation
* Pain when palpating ligament is poorly specific but may indicate injury to structure
* Check sites for Ottawa ankle rules to evaluate if there may be an associated fracture with injury
* Posterior edge or tip of lateral malleolus (6 cm)
* Posterior edger or tip of medial malleolus (6 ...
