HPI: Middle-aged male s/p MCC.
PE: Ecchymoses, swelling, and tenderness about ankle. Tender over proximal fibula and pain with squeezing of calf.
Figure 1: Mortise view of ankle showing widened mortise medially
Figure 2: Leg film showing proximal fibular fracture
- Divided into grades
o I: Minor, no significant ligamentous damage. Able to bear weight.
o II: Associated with partial ligamentous tear. Significant ecchymoses/swelling. Difficulty bearing weight.
o III: Associated with complete ligamentous tear. Significant functional loss and universal inability to bear weight.
- When should we obtain radiographs?:
o If pretest clinical suspicion is high based on mechanism of injury or patient cannot be ruled out for fracture based on Ottawa ankle rules:
Syndesmotic injuries (AKA “high” ankle sprains):
o PE and mechanism:
- Otherwise patient needs syndesmotic screw fixation. Patient can be immobilized and follow-up as an outpatient for surgical fixation
CMC ER Residents
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