Ankle problems: Answer

Here’s the xray again.

Patient’s fracture was read as an ankle fracture-dislocation. Posterior dislocation of talus and tibiotalar articulation. Comminuted fractures in distal fibula, posterior malleolus and medial mallelous.

Orthopedics was consulted. Several reduction attempts were made by ortho, but ankle was unstable and reduction was not able to be held by splint. Patient was taken to the OR for reduction and external fixation.

Ankle Fractures:

Types:

• isolated medial malleolus fracture
• isolated lateral malleolus fracture
• bimalleolar and bimalleolar-equivalent fractures (both lateral and medical malleolus involved)
• posterior malleolus fractures
• Bosworth fracture-dislocations (fracture-dislocation of the ankle where the fibula becomes entrapped behind the tibia and becomes irreducible)
• open ankle fractures

Treatment:

Stable: splint or short walking cast

• isolated nondisplaced medial malleolus fracture or tip avulsions
• isolated lateral malleolus fracture with < 3mm displacement and no talar shift
• posterior malleolar fracture with < 25% joint involvement or < 2mm step-off

◦Posterior splint

◦Sugar tong/short leg stirrup splint

Unstable (fracture-dislocation, bimalleolar or trimalleolar fracture, or lateral malleolar fracture with talar shift.)

• ortho consult, possible operative repair (ORIF)
• closed fracture:

o   reduction with hematoma block or procedural sedation

• open fracture:

o   tetanus

o   cover with wet to dry dressing

o   ancef

o   operative repair

Tintinalli’s Emergency Medicine:  A Comprehensive Study Guide

Wheeless’ Textbook of Orthopaedics online

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