We dissect one of the most common injuries we see in the ER -- ankle sprains Hosts: Brian Gilberti, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Ankle_Sprains.mp3 Download Leave a Comment Tags: Orthopedics Show Notes Background * Among most common injuries evaluated in ED * A sprain is an injury to 1 or more ligaments about the ankle joint * Highest rate among teenagers and young adults * Higher incidence among women than men * Almost a half are sustained during sports * Greatest risk factor is a history of prior ankle sprain Anatomy * Bone: Distal tibia and fibula over the talus → constitutes the ankle mortise * Aside from malleoli, ligament complexes hold joint together * Medial deltoid ligament * Lateral ligament complex * Anterior talofibular ligament * Most commonly injured * Weakest * 85% of all ankle sprains  * Posterior talofibular ligament * Calcaneofibular ligament * Syndesmosis Mechanism of Injury * Lateral ankle sprains  * Most common among athletes * ATFL most commonly injured * Combined with CFL in 20% of injuries * 2/2 inversion injuries * Medial ankle sprains * Less common than lateral because ligaments stronger and mechanism less frequent * More likely to suffer avulsion fracture of medial malleolus than injure medial ligament * 2/2 eversion +/- forced external rotation * Typically landing on pronated foot -> external rotation * High Ankle sprains * Syndesmotic injury * More common in collision sports (football, soccer, etc) * Grade I * Mild * Stretch without “macroscopic” tearing * Minimal swelling / tenderness * No instability * No disability associated with injury *     Grade II * Moderate * Partial tear of ligament * Moderate swelling / tenderness * Some instability and loss of ROM * Difficulty ambulating / bearing weight *     Grade III * Severe * Complete rupture of ligaments * Extensive swelling / ecchymosis / tenderness * Mechanical instability on exam * Inability to bear weight Examination *     Beyond visual inspection for swelling, ecchymoses, abrasions, or lacerations * Palpation  * Pain when palpating ligament is poorly specific but may indicate injury to structure