2.  18 yo WF pw ankle pain.
While walking, she
stumbled across an exposed
root and twisted her ankle
and fell. She reports pain
in her ankle and says the
inside of her ankle looks
weird. Pain is 10/10 but she
denies all other pain
including pain in her
head, neck, back and
contralateral lower
extremity.
 T 99.6 P 112 BP 126/84 O2




97%
Gen: Obvious discomfort
2/2 pain.
CV: Tachycardic, no
m/r/g
Pulm: CTAB.
MSK: Left ankle with
obvious bony abnormality
at med mal. NV intact.
Decreased ROM, active
and passive at L ankle.
TTP at proximal fibula
(ipsilateral).

5.  Elevate and Ice Foot
 Analgesics
 Reduce if possible
 If stable, immobilize – long leg cast, non weight
bearing, crutches f/u with orthopedics in
 Follow up with Orthopedics in 1 week
 If unstable, immobilize, emergent ortho consult

6.  This fracture includes proximal fracture of
fibula, avulsion fracture of medial malleolus, and
syndesmosis disruption.
 Typically does poorly with conservative treatment so
prepare patient for high likelihood of internal fixation.
 Similar to Galeazi and Monteggia fractures.
 Anticipate this in someone c/o ankle pain. Make sure
to palpate the entire tibia and fibula.

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.
Evidence-based treatment of maisonneuve fractures. Stufkens
SA, van den Bekerom MP, Doornberg JN, van Dijk CN, Kloen P. J
Foot Ankle Surg. 2011 Jan-Feb;50(1):62-7.
Maisonneuve fracture. Millen JC, Lindberg D. J Emerg Med. 2011
Jul;41(1):77-8