![]() Additionally, one can perform an external rotation stress test which has the foot start in a neutral position followed by external rotation of the tibia. The “Squeeze Test” requires palpation of the tibia and fibula at the mid-calf level and if it returns positive for tenderness, it suggests a syndesmotic injury ( Figure 2a). Patients may only report ankle pain with significant swelling, but it is important to examine the joints above and below the ankle. ![]() Patients may recall a twisting motion to their ankle but not always. Physical Exam:įor all patients with ankle injuries, it is extremely important to rule out a Maisonneuve fracture. Lastly, as the force is traveling through the deltoid ligament and medial malleolus, up towards the syndesmotic ligaments and interosseous membrane, the force generated exits the proximal fibula via fracture. Acting as a wedge, the talus places pressure on the lateral malleolus and causes syndesmotic disruption between the tibia and fibula. The talus externally rotates and applies stress to the medial aspect of the ankle and may cause deltoid ligament rupture or medial malleolus fracture. This extreme force places significant strain on the bones and ligaments that make up the ankle joint and often results in instability. Maisonneuve fractures are a result of external rotation of a planted foot, most often with pronation of the foot.
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