8. INITIAL MANAGEMENT
“DR, WE HAVE AN ANKLE FRACTURE IN ED…”
• ATLS PRINCIPLES
• FOCUSED HISTORY & EXAMINATION
• ASSESSMENT OF SOFT TISSUES (OPEN/CLOSED, SWELLING)
• NEUROVASCULAR STATUS
• X-RAYS?
• AP/LATERAL/MORTISE +/- KNEE
9. SUBSEQUENT MANAGEMENT
“DR, WE HAVE AN ANKLE FRACTURE IN ED…”
• IMMOBILISATION +/- MANIPULATION
• BOOT / BACKSLAB / EX-FIX
• RE-ASSESS NEUROVASCULAR STATUS
• REPEAT X-RAY
• CT SCAN?
• HOME / ADMIT
• ELEVATE / NBM
10. CASE STUDIES
• 24M TWISTED ANKLE PLAYING FOOTBALL
• CLOSED, NV INTACT, NO OTHER INJURIES
• BOOT + HOME
11. CASE STUDIES
• 32F FELL WHILST DANCING
IN HEELS
• CLOSED, NV INTACT, NO
OTHER INJURIES
• BOOT, HOME & WB X-RAY
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the patient may be supine or sitting upright with the leg straightened on the table
the leg must be rotated internally 15° to 20°, thus aligning the intermalleolar line parallel to the detector. This usually results in the 5th toe being directly in line with the centre of the calcaneum
internal rotation must be from the hip; isolated rotation of the ankle will result in a non-diagnostic image
foot should be in slight dorsiflexion
Weakness of ankle dorsiflexion/subtalar joint (foot) eversion and/or numbness along the lateral lower leg/dorsum of the foot should raise clinical suspicion for a Maisonneuve injury.
Weakness of ankle dorsiflexion/subtalar joint (foot) eversion and/or numbness along the lateral lower leg/dorsum of the foot should raise clinical suspicion for a Maisonneuve injury.
