1. 1. Emergency Room: Foot and Ankle Injuries Selene G. Parekh, MD, MBA Associate Professor of Surgery Partner, North Carolina Orthopaedic Clinic Department of Orthopaedic Surgery Adjunct Faculty Fuqua Business School Duke University Durham, NC 919.471.9622 http://seleneparekhmd.com Twitter: @seleneparekhmd
2. 2. Ankle Sprains
3. 3. Lateral Ankle Sprains Most common specific injury in sports Finland 16-21% of all sports injuries Basketball 45% of injuries Soccer 31% of injuries Anatomy
4. 4. Lateral Ankle Sprains Most common specific injury in sports Finland 16-21% of all sports injuries Basketball 45% of injuries Soccer 31% of injuries Anatomy
5. 5. Lateral Ankle Sprains Most common specific injury in sports Finland 16-21% of all sports injuries Basketball 45% of injuries Soccer 31% of injuries Anatomy
6. 6. Lateral Ankle Sprains Most common specific injury in sports Finland 16-21% of all sports injuries Basketball 45% of injuries Soccer 31% of injuries Anatomy
7. 7. Lateral Ankle Sprains Biomechanics Dorsiflexion: ATFL loose, CFL taut Plantarflexion: ATFL taut, CFL loose ATFL Adduction in PF, restricts IR of talus in mortise CFL Adduction in neutral/DF PTFL Prevents ER in DF IOL Controls rotation
8. 8. Lateral Ankle Sprains Pathology Associated injuries Tear of P. long/br. Talar chondral injury Medial ligament & syndesmotic injuries Fx lateral talus & fibula, 5th metatarsal fx, anterior process calcaneus fx Post-sprain neuritis
9. 9. Lateral Ankle Sprains Diagnosis Immediate swelling & pain, difficulty WB Tenderness over affected structures ROM Pain with anterior drawer, suction sign with anterior subluxation of talus Inversion stress- pain/instability
10. 10. Lateral Ankle Sprains Radiologic Evaluation 3 views Talar Tilt Anterior drawer MRI
11. 11. Lateral Ankle Sprains Clanton Classification I - Stable symptomatic tx II - Unstable Group 1: non-athlete, older functional tx Group 2: young athlete A: (-) stress test functional tx B: (+) stress test surgical C: Subtalar instability functional tx
12. 12. Lateral Ankle Sprains Acute RICE Mobilization with support Lace-up, stirrup brace, walking boot, cast Atrophy, stiffness Physical therapy ROM, peroneal, dorsiflexor strengthening, Achilles stretching Proprioceptive: wobble, mini-trampoline
13. 13. Lateral Ankle Sprains Surgical treatment Acute Controversial Young athlete Gross instability Associated fracture Talocrural dislocation Direct repair/fixation of bony fragments
14. 14. Surgical Options Modified Brostrum Imbricate using native tissue Supplement using IER Anatomic allograft reconstructions
15. 15. Old Technique vs New Technique Chrisman Snook / Watson Jones Style Anatomic Secondary Procedure using Bio Tenodesis Screws
16. 16. Lateral Ankle Ligament Reconstruction w/ Free Graft Overview Courtesy of Tom Clanton, MD
17. 17. Anatomic Weave
18. 18. Anchoring in Calcaneus
19. 19. Talar Anchor Point
20. 20. Talar Anchor Point
21. 21. Knee Surg SportTram Arth 2012 Use of semitendinosus allograft tendon for chronic lateral ankle instability Retrospective study of n=28 ankles Reconstruction ATFL/CFL with interference screws Mean follow-up 19 months VAS scores 62 (p