Musculoskeletal case studies for medical students

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A 32 year old female twisted her ankle.

The fracture was closed but there was marked swelling over the whole ankle including the distal fibula.

Neurovascular intact, no other injuries
Initial X ray
Description AP X ray
X ray
Description Lateral x ray
Problem The 32 year old female who suffered an ankle injury. How this was treated, and why.
X ray after treatment
Description After closed reduction
Post management further view
Description After open Reduction
Classification There is a fracture of the medial malleolus as well as the lateral malleolus. The fracture of the lateral malleolus is at he level of the joint and there is talar shift of the distal tibia laterally. On the lateral x ray a posterior malleolus fracture can also be seen, the talus is severely subluxed posteriorly.
Discussion of management The fracture needed immediate closed reduction to prevent further swelling. This was done - (see x ray left). Here a fair reduction was achieved and a backslab was applied. The swelling would have made immediate ORIF not advisable. She was admitted to lie with the foot elevated until the swelling had subsided. An ORIF with plate to the fibula, and two screws to the medial malleolus, was done 10 days later (see x ray on right)


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