Musculoskeletal case studies for medical students
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A 25 year old man sustained a rugby injury. Closed injury, neurovascular intact, no other injuries.
Initial X ray
A P x ray
The 25 year old rugby player with an ankle injury. How this was treated, and why.
X ray after treatment
After open reduction and internal fixation
Post management further view
There is a fractures of the lateral malleolus. The fibular fracture starts at ankle level and extends up the fibula. There is marked talar shift (lateral movement of the talus relative to the distal tibia). Although the medial malleolus is not fractured, the deltoid ligament must have ruptured to allow this degree of shift. In terms of classification, the ligament rupture counts as a malleolar fracture. This patient's injury can be classified as a Weber B fracture.
Discussion of management
What could you do as as the rural doctor who first saw this case?
Reduce the ankle immediately under GA or sedation. The foot needs to be dorsiflexed and medial pressure put on the talus to reduce it on the tibia. A backslab will then need to be applied and a check x ray taken. The Patient needs admission with elevation of the foot- just above the level of the heart. Intermittent ice packs can be applied to further reduce selling. If facilities for open reduction and internal fixation are not available at your hospital, the patient can now be referred for this.
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