MCQ Orthopedics Answer 29

The Correct Answer is C

This patient has an uncomplicated lateral ankle sprain and requires minimal intervention. Early range-of-motion exercises should be initiated to maintain flexibility.

The Ottawa ankle rules were developed to determine when radiographs are needed for ankle sprains. In summary, ankle radiographs should be done if the patient has pain at the medial or lateral malleolus and either bone tenderness at the back edge or tip of the lateral or medial malleolus, or an inability to bear weight immediately after the injury or in the emergency department, or both. If the patient complains of midfoot pain and/or bone tenderness at the base of the fifth metatarsal or navicular, or an inability to bear weight, radiographs should be ordered.

Sprains can be differentiated from major partial or complete ligamentous tears by anteroposterior, lateral, and 30° internal oblique (mortise view) radiographs. If the joint cleft between either malleolus and the talus is > 4 mm, a major ligamentous tear is probable. Stress radiographs in forced inversion are sometimes helpful to demonstrate stability, but ankle instability can be present with a normal stress radiograph.

Grade I and II ankle sprains are best treated with RICE (rest, ice, compression, elevation) and an air splint for ambulation. NSAIDs are used for control of pain and inflammation. Heat should not be applied. Weight bearing is appropriate as tolerated and functional rehabilitation should be started when pain permits but not necessarily within the first 24 hours after injury. Exercises on a balance board will help develop coordination.

Ref: Rakel RE: Textbook of Family Practice, ed 6. WB Saunders Co, 2002, pp 922-924.

Category: Orthopedics MCQs