Les connaissances des internes de médecine générale de la région Auvergne-Rhône-Alpes sur les entorses de cheville : une étude transversale descriptive

Introduction: Ankle sprains are the most common musculoskeletal injury. More than 6000 ankle sprains are diagnosed every day in France, which represent around 950.000 per year. Despite the fact that ankle sprains are commonplace, they are associated with significant morbidity, with almost 40% of cases complicated by chronic instability, and within that group, 20% are victims of premature talocrural osteoarthritis. Studies led on General Practitioners show room for improvement with poorly applied recommendation. No study has been carried out on the knowledge of General Practice interns in the Auvergne Rhône Alpes region about ankle sprains, which could be handled differently from their elders. Objective: Get an overview of the knowledge General Practice interns about ankle sprains and their management. Materials and methods: Cross-sectional descriptive study with collection of responses of a questionnaire containing theoretical questions and two clinical cases, and ending with a self-assessment. Results: 97 questionnaires were received, of which 71 were complete across the Auvergne Rhône-Alpes region. The mean score obtained for the "Theory" section was 82,5/100. Clinical case n°1 on external sprains received an average score of 53,0/100. Clinical case n°2 on syndesmosis sprains received an average score of 28,9/100. Discussion: Interns in the region seem to have a good understanding of the anatomy and pathophysiology of lateral sprains. However, injuries to the distal Tibio-Fibular joint are less known, during the interview but also during clinical examination or when additional imaging are requested. Nevertheless, this did not have a proportional impact on immediate management. These results are consistent with the literature, which shows a real under-diagnosis. Their feeling of competence was mitigated. It’s particularly true with regard to the syndesmosis’ clinical case. The vast majority of interns questioned wanted further training on this subject. Conclusion: Ankle sprains are a frequent injury and are linked to a high morbidity. Lesions can be complex due to the multitude of structures involved and the variety of mechanisms. They are one of the types of injuries that can be encountered in general practice. This survey provides an overview of the knowledge of General Practice interns in the Auvergne Rhône Alpes region about the management of ankle ligament injuries. Generally speaking, the interns do not seem to feel very confident with their care. Their knowledge varies from one area to another. Their knowledge of anatomy seems adequate. Clinical examination is the weak spot in their training, whether in terms of applying the Ottawa criteria or using clinical tests. Yet, this doesn’t have a proportional impact on their immediate management, particularly with regard to syndesmosis. In both clinical cases, the near majority, if not the majority, of interns follows the recommendations in the literature. As anticipated, lateral sprains are better known overall than distal tibiofibular syndesmosis sprains. Since ankle sprains can make up 10% of emergency consultations in the region, better understanding and management of these conditions in office-based practice may reduce the pressure on emergency departments and improve the prognosis of these frequent but highly morbid injuries.

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