Ankle Fractures!

Case Presentation: 

Hx:  57 yo M p/w fall from 10 feet complaining of L ankle pain

PE:  Primary survey intact.  Secondary survey for apparent intoxication and ankle deformity.  EFAST negative.  CxR, Pelvis XR and PAN Scan negative.

Ankle Fractures Learning Points:

1)      Anatomy:  The ankle joint is made up of the medial malleolus (distal tibia), the lateral malleolus (distal fibula), posterior malleolus (distal posterior portion of tibia) all of which fit tightly around the talus to form the mortise.  The syndesmosis are the ligaments that hold the tibia and fibula together.

2)      Trimalleolar, bimalleolar, or unimaleolar fractures (with opposite malleolus ligamentous instability) are considered unstable and need orthopedic referral

3)      Isolated unimaleolar fractures are stable

4)      Fibular fractures proximal to the level of the talus have a high association with disruption of the syndesmosis and are considered unstable requiring orthopedic referral

Case Conclusion:  Patient was sedated with Propofol  1mg/kg IV x 1; splinted with short leg posterior splint and discharged with NWB until orthopedic  followup.  Ortho often waits 5-7 days for the swelling to decrease and for what blistering that may occur to not interfere with the surgical incision.

Bonus Question:  Pilon Fractures:  The talus is driven upward into the tibial plafond resulting a comminuted intraarticular trimaleolar fracture with extension into the distal tibial metaphysis usually from a fall from height.  What other injury should you be looking for???

Koehler S, Eiff P.  Overview of Ankle Fractures in Adults  In: UpToDate, Fields, K. (Ed), UpToDate, Waltham, MA. (Accessed on Sept 12, 2014.)