| What is the next step in treatment after reviewing a stable fracture in the outpatient department? | Convert to cast and keep for 6 weeks | ATLS management Limb elevation/ice packs/splintage Stable fracture (Syndesmosis intact Medial joint space maintained in stress views) Review in out patient department at 5-7 days Convert to cast and keep for 6 weeks Plan approach after CT assessment Dual approach Try to fix – 2 malleoli (LM + PM/MM + PM) from a single approach as per surgeon comfort, third malleolus by another approach Non weight bearing mobilisation and exercises should be initiated early. | 179 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | ATLS management Limb elevation/ice packs/splintage Stable fracture (Syndesmosis intact Medial joint space maintained in stress views) Review in out patient department at 5-7 days Convert to cast and keep for 6 weeks Plan approach after CT assessment Dual approach Try to fix – 2 malleoli (LM + PM/MM + PM) from a single approach as per surgeon comfort, third malleolus by another approach Non weight bearing mobilisation and exercises should be initiated early. | 1 | page=1,block=32 | 0.700 | valid |
| What is the purpose of a CT scan in the assessment of ankle fractures? | Detailed assessment of fracture patho-anatomy | • AP View (up to knee joint to look for high fibula fractures) • Lateral View • Mortise view • Stress views - Weight-bearing and external rotation stress views in suspected syndesmotic injuries CT SCAN (DESIRABLE) • Detailed assessment of fracture patho-anatomy ◦To look for suspected posterior malleolar fracture ◦To look for impaction • Preoperative planning for operative approaches and fixation techniques | 216 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | • AP View (up to knee joint to look for high fibula fractures) • Lateral View • Mortise view • Stress views - Weight-bearing and external rotation stress views in suspected syndesmotic injuries CT SCAN (DESIRABLE) • Detailed assessment of fracture patho-anatomy ◦To look for suspected posterior malleolar fracture ◦To look for impaction • Preoperative planning for operative approaches and fixation techniques | 1 | page=1,block=29 | 0.700 | valid |
| What is the purpose of a B/K slab in fracture treatment? | Closed Reduction, check X-ray | • Stop the bleed • Debride for open fracture • Fasciotomy if warranted for impending compartment syndrome • External fixator application • CT scan for detailed assessment Dual approach Fix simple fracture first (Usually fibula) Fix the second fracture (MM) check syndesmotic stability If unstable – Fix with screws (2 preferable)/tightrope Single approach MM-Antero- medial with screws LM - Lateral approach with antiglide plate/anatomical plate B/K Slab Closed Reduction, check X-ray Unstable fracture No Yes | 455 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | • Stop the bleed • Debride for open fracture • Fasciotomy if warranted for impending compartment syndrome • External fixator application • CT scan for detailed assessment Dual approach Fix simple fracture first (Usually fibula) Fix the second fracture (MM) check syndesmotic stability If unstable – Fix with screws (2 preferable)/tightrope Single approach MM-Antero- medial with screws LM - Lateral approach with antiglide plate/anatomical plate B/K Slab Closed Reduction, check X-ray Unstable fracture No Yes | 1 | page=1,block=64 |
| What does the inability to move toes actively indicate? | Suspected Tendon injury/nerve injury | • High-energy trauma in young patients (RTA) • Low-energy twisting injuries in elderly A. Airway and cervical spine B. Breathing and ventilation C. Circulation and haemmorhage control D. Disability and neurological status E. Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle | 764 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle |
| What is suspected if there is pain during passive stretching of toes? | compartment syndrome | • High-energy trauma in young patients (RTA) • Low-energy twisting injuries in elderly A. Airway and cervical spine B. Breathing and ventilation C. Circulation and haemmorhage control D. Disability and neurological status E. Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle | 573 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle |
| What is the purpose of assessing pulse differences between extremities during an ankle injury examination? | Suspected vascular injury | • High-energy trauma in young patients (RTA) • Low-energy twisting injuries in elderly A. Airway and cervical spine B. Breathing and ventilation C. Circulation and haemmorhage control D. Disability and neurological status E. Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle | 703 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle |
| What are the common symptoms of an ankle injury upon presentation? | Pain, swelling, deformity at the ankle | • High-energy trauma in young patients (RTA) • Low-energy twisting injuries in elderly A. Airway and cervical spine B. Breathing and ventilation C. Circulation and haemmorhage control D. Disability and neurological status E. Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle | 416 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle |
| What are the initial management steps for an open fracture? | Fasciotomy and external fixator application | • High-energy trauma in young patients (RTA) • Low-energy twisting injuries in elderly A. Airway and cervical spine B. Breathing and ventilation C. Circulation and haemmorhage control D. Disability and neurological status E. Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle | 276 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | Exposure and environment control Open fracture STW Fasciotomy and external fixator application Urgent reduction and immobilization Management of patient as per ATLS protocols Presentation: • Pain, swelling, deformity at the ankle PHYSICAL EXAM Inspect ▪Look circumferentially to rule-out an open fracture Palpate ▪Tenderness at the ankle ▪Rule out compartment syndrome when pain + on passive stretching of toes Assess ▪Any differences in pulse examination between extremities – Suspected vascular injury ▪Inability to move toes actively – Suspected Tendon injury/nerve injury ▪Dislocated ankle |
| Which imaging views are used for suspected syndesmotic injuries? | Stress views - Weight-bearing and external rotation stress views in suspected syndesmotic injuries | • AP View (up to knee joint to look for high fibula fractures) • Lateral View • Mortise view • Stress views - Weight-bearing and external rotation stress views in suspected syndesmotic injuries CT SCAN (DESIRABLE) • Detailed assessment of fracture patho-anatomy ◦To look for suspected posterior malleolar fracture ◦To look for impaction • Preoperative planning for operative approaches and fixation techniques | 95 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | • AP View (up to knee joint to look for high fibula fractures) • Lateral View • Mortise view • Stress views - Weight-bearing and external rotation stress views in suspected syndesmotic injuries CT SCAN (DESIRABLE) • Detailed assessment of fracture patho-anatomy ◦To look for suspected posterior malleolar fracture ◦To look for impaction • Preoperative planning for operative approaches and fixation techniques | 1 | page=1,block=29 | 0.700 | valid |
| What is the recommended timing for final fixation in fracture management? | once swelling subsides/ blisters resolve/patient physiologically fit | • Active bleed • Suspected compartment syndrome • Open fracture • Simple fracture • HDU/ICU management for multi-system injury • Fasciotomy if required • Vascular repair Final fixation once swelling subsides/ blisters resolve/patient physiologically fit 1. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170. doi: 10.1097/BOT.0000000000001063. PMID: 29256945. 2. LAUGE-HANSEN N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg (1920). 1950 May;60(5):957-85. PMID: 15411319. 3. Stringfellow TD, Walters ST, Nash W, Ahluwalia R; Posterior Malleolus Study Group. Management of posterior malleolus fractures: A multicentre cohort study in the United Kingdom. | 185 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_1_ankle_fractures.pdf | • Active bleed • Suspected compartment syndrome • Open fracture • Simple fracture • HDU/ICU management for multi-system injury • Fasciotomy if required • Vascular repair Final fixation once swelling subsides/ blisters resolve/patient physiologically fit 1. |