Author: Steve

Tillaux fracture

Posted on March 10, 2023 by - Ankle, Fractures, Paediatrics, T

A Tillaux fracture is a specific type of ankle fracture that occurs in children and adolescents. It is caused by a twisting injury to the ankle and is characterized by a fracture of the lateral aspect of the tibial epiphysis.

The tibial epiphysis is the area of developing bone at the end of the tibia that contributes to the growth of the bone. The lateral aspect of the tibial epiphysis is where the fibula bone attaches to the tibia. When a twisting force is applied to the ankle, it can cause the fibula to pull on the lateral aspect of the tibial epiphysis, resulting in a Tillaux fracture.

Symptoms of a Tillaux fracture may include pain, swelling, and difficulty bearing weight on the affected foot. Treatment typically involves immobilization of the ankle with a cast or brace to allow the fracture to heal. In some cases, surgery may be necessary to realign and stabilize the fractured bone.

If left untreated or improperly treated, a Tillaux fracture can lead to long-term complications such as chronic pain, instability of the ankle joint, and an increased risk of developing arthritis in the ankle. Early and appropriate treatment is important for the best possible outcome.

Pott’s fracture

Posted on March 10, 2023 by - Ankle, Fractures, P

Pott’s fracture, also known as a bimalleolar ankle fracture, is a type of ankle fracture that involves the tibia and fibula bones. It is typically caused by a twisting injury or direct trauma to the ankle.

In a Pott’s fracture, both the medial malleolus (the bony protrusion on the inner side of the ankle) and the lateral malleolus (the bony protrusion on the outer side of the ankle) are fractured. This can cause significant pain, swelling, and difficulty bearing weight on the affected foot.

Treatment for Pott’s fracture typically involves immobilization of the ankle with a cast or brace to allow the bones to heal. In some cases, surgery may be necessary to realign and stabilize the fractured bones. Rehabilitation and physical therapy may also be necessary to regain strength and mobility in the affected ankle.

If left untreated or improperly treated, a Pott’s fracture can lead to long-term complications such as chronic pain, instability of the ankle joint, and an increased risk of developing arthritis in the ankle.

Köhler disease

Posted on March 10, 2023 by - K, Midfoot, Paediatrics

Köhler disease, also known as osteochondrosis of the navicular bone, is a rare condition that affects the navicular bone in the foot. It is most commonly seen in children between the ages of 5 and 10 years old, and is more common in boys than girls.

The exact cause of Köhler disease is unknown, but it is believed to be related to a disruption in blood flow to the navicular bone. This can lead to a decrease in bone density and the development of small fractures in the bone.

Symptoms of Köhler disease typically include pain and swelling in the midfoot, particularly on the top of the foot. The affected foot may also appear flattened or widened, and there may be a limp or difficulty walking.

Treatment for Köhler disease usually involves rest and immobilization of the foot with a cast or brace to allow the bone to heal. Pain relievers may also be prescribed to manage discomfort. In rare cases, surgery may be necessary to remove damaged tissue or realign the bones in the foot. With appropriate treatment, most children with Köhler disease recover fully and have no long-term complications.

Anterior talofibular ligament (ATFL) rupture

Posted on March 10, 2023 by - A, Ankle

An anterior talofibular ligament (ATFL) rupture can be classified according to the severity of the injury, as follows:

  1. Grade I: Mild sprain with minimal or no ligament fiber tear. This type of injury usually causes mild swelling and pain, but the patient can still walk normally.
  2. Grade II: Moderate sprain with partial ligament fiber tear. This type of injury causes moderate swelling, pain, and instability of the ankle joint. The patient may experience difficulty walking and may need crutches or a brace to support the ankle.
  3. Grade III: Severe sprain with complete ligament tear. This type of injury causes severe swelling, pain, and instability of the ankle joint. The patient is usually unable to bear weight on the affected ankle and may require surgery to repair the torn ligament.

It is important to note that the severity of the injury does not always correlate with the level of pain or disability experienced by the patient. In some cases, even a mild sprain can cause significant pain and disability, while in other cases, a severe sprain may cause little pain or disability.

Common foot x-ray measurements

Posted on March 10, 2023 by - C, Radiology

Here are 22 of the most common foot X-ray measurements:

  1. Medial malleolar distance: The distance between the medial malleolus (inside ankle bone) and the center of the talus to assess ankle joint stability.
  2. Lateral malleolar distance: The distance between the lateral malleolus (outside ankle bone) and the center of the talus to assess ankle joint stability.
  3. Talar declination angle: The angle between the talar dome (top of the ankle bone) and a horizontal line to assess the vertical alignment of the talus.
  4. Talar-first metatarsal angle: The angle between the long axis of the talus and the long axis of the first metatarsal to assess forefoot and midfoot alignment.
  5. Calcaneal inclination angle: The angle between the calcaneal axis (line from the top of the calcaneus to the bottom) and a line perpendicular to the floor to assess hindfoot alignment.
  6. Talocalcaneal angle: The angle formed between the line bisecting the talus and the calcaneus to assess hindfoot alignment.
  7. Tibiotalar angle: The angle formed between the tibial axis (line from the top to the bottom of the tibia) and the talus to assess ankle joint alignment.
  8. Anterior tibial translation: The distance between the tibial plafond (top of the tibia) and the anterior edge of the talus to assess anterior ankle instability.
  9. Talar tilt angle: The angle between the talar neck (narrow part of the ankle bone) and a line perpendicular to the floor to assess ankle joint instability.
  10. First metatarsophalangeal joint angle: The angle between the first metatarsal and the proximal phalanx of the big toe to assess hallux valgus deformity.
  11. Intermetatarsal angle: The angle between the first and second metatarsals to assess hallux valgus deformity.
  12. Hallux interphalangeal angle: The angle between the proximal and distal phalanges of the big toe to assess hallux rigidus deformity.
  13. Calcaneal pitch angle: The angle between the calcaneal axis and a line perpendicular to the floor to assess hindfoot alignment.
  14. Arch angle: The angle between the navicular bone and the first metatarsal to assess foot arch height.
  15. Naviculocuneiform angle: The angle formed between the navicular bone and the medial cuneiform bone to assess forefoot alignment.
  16. Meary’s angle: The angle formed between the first metatarsal and the talus to assess forefoot alignment.
  17. Metatarsal protrusion distance: The distance between the longitudinal axis of the first metatarsal and the second metatarsal to assess forefoot alignment.
  18. First metatarsal declination angle: The angle formed between the first metatarsal and the ground to assess forefoot alignment.
  19. Sesamoid position: The position of the sesamoid bones (small bones under the big toe joint) to assess hallux valgus deformity.
  20. Distal metatarsal articular angle: The angle between the first metatarsal shaft and the articular surface of the head of the metatarsal to assess hallux rigidus deformity.
  21. Proximal phalanx articular angle: The angle between the proximal phalanx of the big toe and the metatarsal head to assess hallux valgus deformity.
  22. Metatarsal parabola angle: The angle formed between the longitudinal axis of the first metatarsal

Weber classification for fibular fractures

Posted on March 10, 2023 by - Fractures, Radiology, W

Weber fractures are a classification system for fractures of the ankle, specifically the fibula bone. The Weber classification system is based on the location of the fracture relative to the ankle joint and the degree of displacement of the fracture.

There are three types of Weber fractures:

  • Weber A: This is a fracture of the fibula that occurs below the level of the ankle joint. The ankle joint itself is not affected. The fracture may be non-displaced (the bone is still aligned properly) or displaced (the bone is out of alignment). This type of fracture is usually treated with immobilization and rest.
  • Weber B: This is a fracture of the fibula that occurs at the level of the ankle joint. The ankle joint is also affected, as the fracture extends into the ligaments that connect the fibula to the tibia bone. This type of fracture is typically treated with immobilization, rest, and sometimes surgery to realign the bones and stabilize the joint.
  • Weber C: This is a fracture of the fibula that occurs above the level of the ankle joint, often at the level of the syndesmosis (the joint between the tibia and fibula bones). The ankle joint is not usually affected, but there may be significant ligament damage. This type of fracture is often treated with surgery to realign the bones and stabilize the joint.

Overall, the Weber classification system is a useful tool for healthcare professionals in assessing and managing ankle fractures. Treatment options for Weber fractures may include immobilization with a cast or brace, surgery to realign the bones and stabilize the joint, and physical therapy to restore range of motion and strength to the ankle.

Salter-Harris classification for growth plate fractures

Posted on March 10, 2023 by - Fractures, Paediatrics, Radiology, S

The Salter-Harris classification is a system used to classify fractures that involve the growth plate, also known as the epiphyseal plate, in pediatric patients. The growth plate is a cartilage-rich area at the ends of long bones that allows for bone growth and development.

The Salter-Harris classification divides growth plate fractures into five categories, based on the location and extent of the fracture:

Type I: This is a transverse fracture that runs through the growth plate, separating the epiphysis (the end of the bone) from the metaphysis (the shaft of the bone). This is the most common type of growth plate fracture and is usually treated with immobilization and close monitoring.

Type II: This is an oblique fracture that runs through the growth plate and into the metaphysis. This type of fracture is also treated with immobilization and monitoring, and may require more frequent follow-up to ensure proper healing.

Type III: This is a fracture that runs through the growth plate and into the epiphysis. This type of fracture may require more aggressive treatment, such as surgery, to prevent long-term complications such as growth disturbances or joint deformities.

Type IV: This is a fracture that runs through the growth plate, the epiphysis, and the metaphysis. This type of fracture is relatively rare and may require surgical intervention to prevent long-term complications.

Type V: This is a crush injury to the growth plate that results in damage to the cells responsible for bone growth. This type of fracture is also relatively rare and may require surgical intervention to prevent growth disturbances.

The Salter-Harris classification is a useful tool for healthcare professionals in assessing and managing growth plate fractures in pediatric patients. Treatment options for growth plate fractures may include immobilization, closed reduction (manipulation of the bones to restore proper alignment), and surgery in some cases.

Overall, prompt and appropriate treatment of growth plate fractures is important to minimize the risk of long-term complications and ensure proper bone growth and development.

Sanders classification for calcaneal fractures

Posted on March 10, 2023 by - Classification systems, Fractures, Radiology, S

The Sanders classification is a system used to categorize calcaneal fractures, which are fractures of the heel bone in the foot. The classification was developed by Dr. Roy W. Sanders, an American orthopedic surgeon, in 1993.

The Sanders classification divides calcaneal fractures into four categories, based on the location and severity of the fracture:

Type I: This is a simple, non-displaced fracture of the posterior calcaneal tuberosity, which is a bony protrusion at the back of the heel bone. This type of fracture is considered to be relatively minor, and is often treated non-surgically with immobilization and rest.

Type II: This is a displaced fracture of the posterior calcaneal facet, which is the portion of the heel bone that articulates with the talus bone in the ankle joint. This type of fracture can result in joint incongruity (misalignment) and can be associated with long-term complications.

Type III: This is a fracture involving both the posterior calcaneal facet and the middle facet of the heel bone. This type of fracture is more severe than Type II, and is associated with a higher risk of complications.

Type IV: This is a fracture involving the entire calcaneus bone, and is the most severe type of calcaneal fracture. This type of fracture can result in significant joint incongruity and is associated with a high risk of long-term complications.

The Sanders classification can be useful in guiding treatment decisions for calcaneal fractures, as the severity and location of the fracture can impact the likelihood of complications such as joint incongruity and post-traumatic arthritis. Treatment options for calcaneal fractures may include immobilization with a cast or brace, surgery to realign the bones and stabilize the joint, and in some cases, joint replacement surgery.

Overall, the Sanders classification is a valuable tool for healthcare professionals in assessing and managing calcaneal fractures, and can help improve patient outcomes through more targeted and effective treatment.

Hawkins classification for talar fractures

Posted on March 10, 2023 by - Classification systems, Fractures, H, Radiology

The Hawkins classification is a system used to categorize talar fractures, which are fractures of the talus bone in the ankle. The classification was developed by Dr. Herbert Hawkins, an American orthopedic surgeon, in 1970.

The Hawkins classification divides talar fractures into four categories, based on the location and severity of the fracture:

Type I: This is a non-displaced fracture of the talar neck, which is the narrow portion of the talus bone between the body of the talus and the ankle joint. The blood supply to the talus is usually preserved in this type of fracture.

Type II: This is a displaced fracture of the talar neck, which can result in damage to the blood supply to the talus. This type of fracture is considered to be more severe than Type I.

Type III: This is a fracture of the body of the talus, which is the large, rounded portion of the bone that forms the ankle joint. This type of fracture is often associated with significant damage to the blood supply to the talus, and can result in avascular necrosis (death of bone tissue due to loss of blood supply) of the talus.

Type IV: This is a fracture of the posterior process of the talus, which is a small projection on the back of the talus bone. This type of fracture is less common than the other three types, and is generally considered to be less severe.

The Hawkins classification can be useful in guiding treatment decisions for talar fractures, as the severity and location of the fracture can impact the likelihood of complications such as avascular necrosis. Treatment options for talar fractures may include immobilization with a cast or brace, surgery to realign the bones and stabilize the joint, and in some cases, joint replacement surgery.

Overall, the Hawkins classification is a valuable tool for healthcare professionals in assessing and managing talar fractures, and can help improve patient outcomes through more targeted and effective treatment.

Simmonds test

Posted on March 10, 2023 by - Biomechanics, S

The Simmonds test, also known as the Thompson test, is a clinical assessment tool used by podiatrists and other healthcare professionals to evaluate the integrity of the Achilles tendon in the foot and ankle. The test is named after the British surgeon, Sir William John Simmonds, who first described the technique in the early 20th century.

During the Simmonds test, the patient is asked to lie prone (face down) with the feet hanging off the edge of a table or examination bed. The examiner then squeezes the calf muscle with one hand while observing the movement of the foot with the other hand.

If the Achilles tendon is intact, the foot should plantar flex or point downwards when the calf muscle is squeezed. However, if the Achilles tendon is ruptured, there will be no movement of the foot, indicating a complete tear of the tendon.

The Simmonds test can be useful in diagnosing Achilles tendon ruptures, which can occur as a result of overuse injuries or trauma to the foot and ankle. Treatment options for Achilles tendon ruptures may include immobilization with a cast or brace, physical therapy, and in some cases, surgery to repair the torn tendon.

Overall, the Simmonds test is a simple, non-invasive clinical tool that can provide valuable information about the integrity of the Achilles tendon in the foot and ankle, and help guide treatment decisions for a range of foot and ankle conditions.