Transcript
Sarawut Watt.
Extern Conference
ผปวยชายไทยค อาย41 ป ภมลำาเนา อ. ดานขนทด จ.นครราชสมา
CC : ปวดขอเทาขวา 6 ชวโมงกอนมาโรงพยาบาลPI : 6 ชวโมงกอนมาโรงพยาบาล ขบมอเตอรไซคหลบ
สนข เกดลม ขาขวากระแทกพน มอาการปวดเทาขวา ขนมาทนท ขอเทาขวาบวม ขยบไมไดเพราะเจบ ไมม
ชา จงมาโรงพยาบาล
Case Scenerio
A Thai man, Good consciousnessVital Signs stable, AfebrileHEENT : not pale, no jaundiceHeart : normal S1, S2, no murmurLungs : Clear and equal BS both lungs Abdomen : soft, not tender
Physical Examination
Ext : Affected Part Rt. Foot : - abrasion wound 1*3 cm. at medial side of foot, - tender at lateral Malleolus and below medial malleolus, - Limit ROM due to pain , - normal pinprick sensation, - Dorsalis pedis & post. Tibial artery can palpable 2+
Film Right Ankle AP , Lateral View
Film Right Ankle mortise view
Closed fracture of right distal fibular (closed fracture right lateral malleolus)
Diagnosis at ER
- On Right Posterior Short leg slab- Follow up 2 weeks + film Right ankle AP, lateral, Mortise view- Advice : Non weight bearing with crutches
Home Medication- Paracetamol(500) 1tab po prn q 6hr- Tramol(50) 1*3 po pc
Management at ER
Right Bimalleolar Fracture
Definite Diagnosis
Ankle Fracture
Three bones make up the ankle joint Tibia - shinbone Fibula - smaller bone of the lower leg Talus - a small bone that sits between the heel
bone (calcaneus) and the tibia and fibula
Anatomy
Anatomy
Twisting or rotating your ankleRolling your ankleTripping or fallingImpact during a car accident
Causes
Immediate and severe painSwellingBruisingTender to touchCannot put any weight on the injured footDeformity ("out of place")
Symptoms
The Ottawa ankle rules the need for plain films in patients with ankle injury.
Patients should have a plain film, if there is malleolar tenderness and at least one of the following
tenderness along the posterior surface of the distal fibula tenderness along the posterior surface of the distal tibia inability to weightbear after the trauma and when being
assessed
Diagnosis
Ottawa Ankle rules
- AP view- Lateral view- Mortise view (Internal rotation 10 degree)
Plain film of Ankle
AP View TibioFibular Overlap <10mm implies Syndesmosis injury TibioFibular Clear space >5mm implies Syndesmosis injury Talar Tilt >2mm is considered abnormal
Radiographic Measurement
Lateral View Posterior malleolus fracture Subluxation of the talus Angulation of distal fibula Talus fracture Calcaneus fracture
Mortise ViewAbnormal findings• TibioFibular overlap < 1mm• Medial Joint space widening
Classification of distal fibula fractures split fractures into groups by severity
Weber classificationWeber A: below the syndesmosis (stable)Weber B: at the syndesmosis (may be unstable)Weber C: above the syndesmosis (unstable)
Classification
Weber Classification
Nonoperativeshort-leg walking cast/bootindications isolated nondisplaced medial malleolus fracture or
tip avulsions isolated lateral malleolus fracture with < 3mm
displacement and no talar shift posterior malleolar fracture with < 25% joint
involvement or < 2mm step-off
Treatment
Operativeopen reduction internal fixationindications any talar displacement displaced isolated medial or Lateral malleolar fracture bimalleolar fracture and bimalleolar-equivalent fracture posterior malleolar fracture with > 25% or > 2mm step-off open fractures
Wound problems Deep infections Post-traumatic arthritis
Complications
top related