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By;Hikmah JayaIffa Andi Ita MaghfirahPutri Amanda ToboFradita Y
Yunus GuzasiahResha DermawanDwiky Limbersia AriesAdvisor : dr.
Nasrah/dr. Wendelin/ dr. NurJalalSupervisor : dr. M. Phetrus Johan,
M.kes, Sp. OT
Department of Orthopedic and Traumatology Medical
FacultyHasanuddin University
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ANKLE INJURY ? Overuse injuries from componen of the ankle and
foot Often associated with sports activities Appley System
Orthopaedics and Fracture. Chapter 31: Injuries of The Ankle and
Foot
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FUNCTION OF ANKLESarwark JF. Foot And Ankle: Essential Of
Musculoskeletal Care 4. Section 7. P. 733. 2010
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STABILITY OF ANKLE
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SYNDESMOSIS OF ANKLEThompson J.C., Netters Concise Orthopaedic
Anatomy, 2nd ed., Saunders Elsevier. p.121
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RANGE OF MOTION OF THE ANKLESarwark, JF. General Orthopaedics:
Essential of Musculoskeletal Care, Section One. P.11.2010-2011
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MUSCLE OF FOOTTibialis AnteriorEkstensor Hallucis
LongusEkstensor Digitorum LongusGastronemiusSoleusStone. R J, Stone
JA. Muscles Of The Leg and Foot . Atlas Of Musculoskeletal and
Muscle. Chapter nine; P. 186-192.
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Arteries Of FootMoore, Keith L.; Dalley, Arthur F., Clinically
Oriented Anatomy, 5th Edition,
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Nerves Of FootThompson J.C., Netters Concise Orthopaedic
Anatomy, 2nd ed., Saunders Elsevier. p.121
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PATHOPHYSIOLOGYChapman WM. Chapmans Orthopaedic Surgery.
California 2001. Page 2208
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ETIOLOGYAmerican Academy of Orthopaedic Surgeons. Tennis elbow.
[online].2011.[cited,2014 May 29]. Available from:
http://orthoinfo.aaos.org/topic.cfm?topic=a00068
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ANKLE INJURYSPRAINSTRAINFRACTURE
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ANKLE SPRAIN Overuse injury limited to ligament.
Common acute sports injury, 25% in every running or jumping
sports
Mechanism : Invertion of the foot places significant on the
lateral ligament Simon RR, Sherman SC, Koeningskec SJ. Lowe
Extremities. Ankle; Emergency Orthopedics: The Extremities, 5th
Edition.
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PHYSICAL EXAM ANKLE SPRAINEssential Musculosceletal CareSwelling
Ecchymosis Tenderness
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SPECIAL TESTSAnterior Drawer Test
Invertion Stress Test(talar tilt test)Essential Musculosceletal
Care
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IMAGING OF ANKLE SPRAINT2 Weighted Axial image of ATFL
tearUltrasound image of ATFL tear
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ACHILLES TENDON INJURIES Ruptures typically occur after age
30.
Commonly occur in weekend athletes
Mechanism: dorsiflexed ankle with the knee extended (Maximal
Streatching).Wheeless' Textbook of Orthopaedics: Achilles Tendon
Injury
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Hyper-dorsiflexion sign Palpable gap in tendon Tenderness
Difficulty Standing on toes Examination Thompson Test
Wheeless' Textbook of Orthopaedics: Achilles Tendon
InjuryPHYSICAL EXAM ACHILLES TENDON INJURY
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Rebecca Aspden, Achilles Tendon Rupture USG OF ACHILLES TENDON
INJURY
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MRI ACHILLES TENDON INJURY
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Handbook of Fractures, 3rd EditionAnkle fractures refer to
fractures of the distal tibia, distal fibula, talus, and
calcaneus.The highest incidence of ankle fractures occurs in
elderly women.Open fractures are rare, accounting for just 2% of
all ankle fractures.
Ankle Fracture
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PHYSICAL EXAM ANKLE FRACTURESwelling EkimosisTendernessCannot
put any weight on the injured footDeformity ("out of place"),
particularly if the ankle joint is dislocated as wellHandbook of
Fractures, 3rd Edition
Handbook of Fractures, 3rd Edition
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LAUGE-HANSEN CLASIFICATIONHandbook of Fractures, 3rd
EditionMECHANISM: Inversion of The foot places significant stress
on the lateral ligaments
Mechanism Injury Laughe-Hensen
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Handbook of Fractures, 3rd EditionMechanism Injury
Laughe-Hensen
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WEBER CLASIFICATIONHandbook of Fractures, 3rd EditionThe Weber
classification system is based on the location of the fibula
fracture.
Weber Afracture below the level of the ankle joint Weber
Bfracture originates at the level of the ankle joint Weber
Cfracture above the level of the ankle joint
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ANKLE FRACTURE Normal FractureHandbook of Fractures, 3rd
Edition
Handbook of Fractures, 3rd Edition
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MORTISE X-RAY:This is taken with the foot in 15 to 20 degrees of
internal rotation to offset the intermalleolar axis.A medial clear
space >4 to 5 mm is abnormal and indicates lateral talar
shift.Talocrural angle: The angle subtended between the
intermalleolar line and a line parallel to the distal tibial
articular surface should be between 8 and 15 degrees. The angle
should be within 2 to 3 degrees of the uninjured ankle.Tibiofibular
overlap 1 mm is abnormal.Handbook of Fractures, 3rd Edition
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ANKLE SPRAIN TREATMENTSaluta, Jonathan. Managing foot and ankle
injuries in athletes. Journal Of Musculoskeletal Med. September
2010RICEBRACINGNSAID
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TENDON ACHILLES RUPTURE TREATMENT Nonsurgical Treatment : Acute
RuptureRICEHeel LiftA. Metzl, Joshua. The ruptured Achilles tendon:
operative and non-operative treatment options. Current Review in
Musculoskeletal Medicine. 2008 1:161-164.
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Surgical Treatment : Severe RuptureTENDON ACHILLES RUPTURE
TREATMENT A. Metzl, Joshua. The ruptured Achilles tendon: operative
and non-operative treatment options. Current Review in
Musculoskeletal Medicine. 2008 1:161-164.
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Nonsurgical Treatment : Stable FractureANKLE FRACTURE
TREATMENTAnkle SplintAnkle BracingAmerican Academy of Orthopaedic
Surgeons. Ankle Fractures [online]. 2011. [cited: 20 May 2014].
Available from:
http://orthoinfo.aaos.org/topic.cfm?topic=a00391
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Surgical Treatment : Unstable FractureANKLE FRACTURE
TREATMENTAmerican Academy of Orthopaedic Surgeons. Ankle Fractures
[online]. 2011. [cited: 20 May 2014]. Available from:
http://orthoinfo.aaos.org/topic.cfm?topic=a00391
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REHABILITATION OF ANKLEAmerican Academy of Orthopaedic Surgeons.
Tennis elbow. [online].2011.[cited,2014 May 29]. Available from:
http://orthoinfo.aaos.org/topic.cfm?topic=a00068Sarwark J.F.
Physical Examination of the elbow and forearm. In Essentials of
Musculoskeletal Care 4. USA. 2010. Page 375-6
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HOME EXERCISE PROGRAM FOR ANKLE SPRINE
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HOME EXERCISE PROGRAM FOR ACHILLES TENDINOSIS
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COMPLICATION OF ANKLE INJURYCOMPLICATION OF ANKLE INJURY
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THANK YOU
-Typical region of tenderness with a lateral ankle
sprain*-anterior drawer test: the clinician will hold the leg with
one hand while gently attempting to pull the foot forward with the
other. This test is positive if there is excessive anterior
translation of the foot with regard to the leg.-talar tilt test,
the clinician holds the leg with one hand and then gently tilts the
heel inward with the other. This test is positive if there is
excessive tilting of the heel with this maneuver. Whether
performing an anterior drawer test or talar tilt test, the
uninjured ankle should always be tested first. This will serve as a
baseline to determine an individual's normal degree of ligamentous
laxity, or lack thereof.*From essential of musculoscletal
carePicture from essential 12.27. Tendo calcaneus (4): Thomsontest:
Normally when the calf is squeezed thefoot moves as the ankle
plantarflexes. Loss ofthis movement is pathognomonic of an
acuterupture of the tendo calcaneus*Achilles tendon rupture seen at
sonography: discontinuity over several centimeters (red line). No
fracture or avulsion (radiograph).Achilles tendon rupture seen at
sonography: discontinuity over several centimeters (red line). No
fracture or avulsion (radiograph).
Longitudinal sonogram showing partial partial-thickness tear
Tendon is markedly thickened and hypoechoic.*Figure 1 shows
magnetic resonance imaging (MRI) of a normal heel and Achilles
tendon. Figure 2 shows a torn Achilles tendon with fluid collected
at the site of the tear. *Open fractures are rare, accounting for
just 2% of all ankle fractures. The highest incidence of ankle
fractures occurs in elderly women.Most ankle fractures are isolated
malleolar fractures, accounting for two-thirds of fractures, with
bimalleolar fractures occurring in one-fourth of patients and
trimalleolar fractures occurring in the remaining 5% to 10%.
**Essential Of Musculoskeletal p.766*Esential Musculosceletal
care p.761*