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.
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