Core EM - Emergency Medicine Podcast

Episode 172.0 – Ankle Sprains

11.04.2019 - By Core EMPlay

Download our free app to listen on your phone

Download on the App StoreGet it on Google Play

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

Download

3 Comments

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 ...

More episodes from Core EM - Emergency Medicine Podcast