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Anterior talofibular ligament (ATFL) sprain
62%
8/13
Calcaneofibular ligament (CFL) sprain
15%
2/13
Deltoid ligament sprain
8%
1/13
Tibia fracture
0%
0/13
Fibula fracture
Select Answer to see Preferred Response
Most ankle sprains are caused by inversion with some degree of plantarflexion resulting in injuries to the lateral ligaments (ATFL sprain is much more common than CFL sprain). Clinical maneuvers can help identify which ligaments are injured. The anterior drawer test (Illustration A), in which the examiner pushes the tibia posteriorly to observe the amount of posterior translation at the lateral aspect of the ankle, assesses the integrity of the ATFL. The talar tilt test (Illustration B), in which the examiner inverts the foot while palpating the talus to determine if tilting occurs, assess the laxity of the CFL. Tiemstra discusses treatment for sprained ankles, stating that it should include rest, ice, compression, elevation (RICE). Early mobilization speeds healing and reduces pain more effectively than prolonged rest. Pharmaceutical pain control can include NSAIDs, acetaminophen, and mild opioids. Prevention of future strains can include emphasis of ankle support and focused neuromuscular training. Bachmann et al. review the accuracy of the Ottawa ankle rules to exclude fracture and radiographic necessity of the ankle. The ankle assessment includes: ability to walk 4 steps (immediately after the injury or at the ER) and localized tenderness of the posterior edge of the medial and lateral malleolus (4 spots). The mid-foot assessment includes: ability to walk 4 steps and tenderness at navicular or base of the fifth metatarsal. They conclude that the Ottawa rule is an accurate instrument for excluding fractures and has a sensitivity of almost 100%. Illustration A shows the Anterior Drawer Test, which is used to assess the integrity of the anterior talofibular ligament. Illustration B shows the Talar Test, which is used to assess the integrity of the calcaneofibular ligament. Illustration C shows summary of the Ottawa ankle and mid-foot rules, highlighting focal areas of tenderness that indicate that a fracture is more likely. Illustration D shows a lateral view of the ankle and ligaments that maintain articulation. Incorrect Answers Answer 2: Calcaneofibular ligament (CFL) sprain occurs with ankle dorsiflexion and inversion Answer 3: Deltoid ligament sprain is rare because this ligament is stronger Answer 4 and 5: According to Ottawa ankle rules, there is a low likelihood of fracture.
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