Episode 172.0 – Ankle Sprains Core EM - Emergency Medicine Podcast

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 ...