Pediatric emergency medicine trisk 0810 0810
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (128.15 KB, 1 trang )
are rare because of the great strength of this ligament. If the deltoid ligament has
been damaged, the tibiofibular syndesmosis is usually disrupted along with it.
Injuries to the tibiofibular syndesmosis may be explored by (i) squeezing the
midshafts of the tibia and the fibula together, (ii) dorsiflexing and then externally
rotating the foot while holding the tibia and the fibula stable, or (iii) forcefully
dorsiflexing the ankle with the patient supine. Exacerbation of pain with these
maneuvers suggests syndesmotic disruption.
Stability Testing
An attempt should be made to assess the stability of the ankle joint. However,
stability testing in the immediate postinjury period may be limited significantly
by pain, swelling, and/or muscle spasm. Several maneuvers are useful, but they
are generally not performed if an ankle fracture is present.
Anterior drawer test —The ATFL is the only structure that prevents forward
subluxation of the talus. The anterior drawer test assesses the anterior stability
of the ankle joint and the integrity of the ATFL (Fig. 40.9 ). The test result is
positive if the foot can be pulled forward by more than 4 mm or if there is a
significant difference in the degree of anterior movement in the injured ankle
compared with the normal ankle.
Talar tilt test —This test examines the lateral stability of the ankle joint. Firmly
adducting the heel, looking for increased laxity compared with the noninjured
joint ( Fig. 40.9 ). Both the ATFL and CFL must be torn to cause gross lateral
ankle instability.
