Ankle sprain

Entorses de la cheville

1- General:

A- Ligaments:

It relates to the lateral collateral ligament (external) in almost all cases. A break in the year-terieur talofibular ligament (LTFA) then break the talocalcaneal ligament (LTC) and finally the posterior ligament talofibular (LTFP) in case of major trauma; these three ligaments are the lateral collateral ligament.

B- Mechanism:

Forced inversion of the foot is the most common mechanism (varus + supination)

Cage:

young man. Before puberty the epiphyseal detachment is more common; beyond 40-50 years, the fractures bimalleolar take over.

2 Clinic:

Pain, typically in 3 times: rapid and greatly reducing and then wakes up. It has no predictive value on the severity of the sprain.

A- Functional signs of severity:

– Audible Crunch

– Dislocation of Sensation

– Sign of the eggshell (hematoma)

B- Physical signs:

– Sign of Clayton groove varus between the talus and fibula. He signed a capsular rupture.

– Anteroposterior laxity (drawer) and especially laxity latéromédiale (rocker) in varus. => Severe sprain.

C- Ottawa criteria:

Radiographs will be required if:

* Patient over 55 or under 18

* Inability to 4 not in full support

* Pain on palpation of the base of the fifth metatarsal of the navicular (scaphoid), the ankles.

3- Imagery:

– Ankle face at 20 ° of internal rotation (mortise) and ankle profile (metatarsal base)

– Only a clinical doubt on differential diagnosis will be made a place of cliché forefoot ¾

– Dynamic radiographs are of interest as part of the evaluation of chronic instability (not useful in emergencies)

– Ultrasound: effective for the detection of ligament injuries but is operator-dependent and equipment

4- Classification:

A- classification O’Donoghue:

– Mild sprain: Simple stretching of the ligament LTFA

– Average sprain: Partial rupture of the ligament LTFA (moderate laxity)

– Severe sprain: complete rupture of the CFL LTFA +/- +/- LTFP

B- Cast Classification:

– Stage 0: no ligament rupture (no laxity)

– Stage 1: breaking the LFTA ligament (anterior drawer)

– Stage 2: CFL breaks in LTFA and ligaments (laxity in valgus)

– Stage 3: breakdown of 3 beams.

5- Differential diagnosis:

– Fracture of the base of the fifth metatarsal (by pulling the tendon of peroneus brevis)

– Other fractures: navicular (scaphoid tarsal); calcaneus; tibial pilon; bimalléolaire …

– Attacks tendinomusculaires and ligament (subtalar sprain, sprained the anterior tibiofibular ligament ….)

Medial collateral ligament sprain (internal).

It is rarely isolated; often associated with bimalléolaire fracture or a fracture of the fibula above located (Maisonneuve fracture)

These two diagnoses requiring surgical treatment

6- Complication:

– Chronic Ankle Instability (complicates 5-20% of ankle sprains) -> recurrent sprains. dynamic radiography. Changes can be made to the talocrural osteoarthritis

– Anterolateral conflict: linked to the interposition of hypertrophic scar tissue between upper-side slope angle and lateral malleolus

– Osteoarthritis talocrural

– Thromboembolic Complication

– Algodystrophie

7- Treatment:

– Protocol “Greek” or (RICE): ice, rest, elevation (raised foot), contention (strapping or plaster splint)

– Medical treatment: NSAIDs, analgesics, anticoagulants reserved for patients at risk

– Consultation in 3rd and 5th days (for the new classification Trevino)

– Functional rehabilitation is absolutely essential

– Surgical treatment is the rule for subluxation and dislocation of the peroneal tendons and osteochondral fractures

– In case of serious breaches:

* Non-sporting Patients: cast boot for 5-6 weeks with anticoagulants or removable orthosis

* Patients sports: surgery + removable splint for 4 weeks + rehabilitation (2 months). The proof of its superiority over the functional treatment is not established.