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 ...