2. 12 YOM presents with pain
in right ankle. He was
running across a field when
he stepped in a hole with
his right leg and fell. He
thinks he twisted when he
fell but not sure. He heard
a loud crack and has not
been able to walk on his
right leg since. Says it
looks funny. Pain is severe.
Denies paresthesias and
numbness.
T 97.8 P 112 BP 138/84 O2
97%
Gen: Obvious discomfort.
CV: Tachycardic, no
m/r/g
Pulm: CTAB.
MSK: R ankle with
obvious bony abnormality
and angle. NV intact. TTP
at malleoli. No ROM,
active or passive. No TTP
at proximla fibuila, base
of 5th MT, or calcaneus.
3.
4.
5. Analgesics and Antiemetics
Sedate and Reduce
Immobilize – Short leg posterior splint with stirrup
Non weight bearing
Emergent ortho consult: surgery vs casting
6. Management is controversial (surgery vs conservative
management). Shift has been towards surgery
recently.
Studies have shown that bimalleolar fractures are more
common in women, people over 60 years of age, and
patients with existing comorbidities
Most will require ORIF.
Fractures are classified by location of fibular fracture
7.
8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide.
O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski,
David M. Cline. McGraw-Hill Professional Publishing: 2010.
Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.
Management of unstable ankle fractures and syndesmosis injuries
in athletes. Jelinek JA, Porter DA. Foot Ankle Clin. 2009
Jun;14(2):277-98.
Nonoperative treatment of bimalleolar equivalent ankle
fractures: a retrospective analysis of 51 patients. Oztürk A,
Ozkan Y, Yalçin N. J Foot Ankle Surg. 2008 Jul-Aug;47(4):372
