Case Presentation by Dr. Daniel Hutchens, MD
66 year old female presents with right ankle pain after slipping on a mat and twisting it. She was unable to bear weight on it immediately after the fall. She noticed immediate pain and swelling. She denies pain in any other joints. She denies any loss of consciousness. She has no other complaints.
Cardiovascular: Regular rate and rhythm, no murmurs, no S3/S4, radial and dorsalis pedis pulses present and equal bilaterally in both upper and lower extremities.
Musculoskeletal: Obvious deformity of the right ankle. Decreased range of motion in the right ankle when compared to the left. Tenderness to palpation over the right medial malleolus. No tenderness to palpation over the distal tibia or fibula. Mild tenderness to palpation over the right fibular head.
Neurologic: Alert and oriented to person, place, and time. Smile symmetric, tongue protrudes midline, uvula raises midline, eyebrows raise symmetrically, eyes close with equal strength. Sensation to light touch equal and intact in bilaterally lower extremities.
- What musculoskeletal physical exam points must be covered in a patient with traumatic ankle pain?
a. Assessment for deformity, range of motion, palpation of inferior and posterior edges of medial/lateral malleoli, and first 6 inches of fibula and tibia.
b. Assessment for deformity, range of motion, palpation of inferior and posterior edges of medial/lateral malleoli, first 6 inches of fibula and tibia, and calcaneous.
c. Assessment for deformity, range of motion, palpation of medial/lateral collateral ligaments, syndesmotic ligaments, inferior and posterior edges of medial/lateral malleoli, entire length of fibula and tibia.
d. Assessment for deformity, range of motion, palpation of medial/lateral collateral ligaments/syndesmotic ligaments, inferior and posterior edges of medial/lateral malleoli, entire length of fibula and tibia, base of the 5th metatarsal, and calcaneous.
- What is your radiologic diagnosis?
a. Pott’s fracture
b. Maisonneuve fracture
c. Cotton fracture
d. Dupuytren’s fracture
- What is the best disposition of this patient with this type of fracture?
a. Walking boot with orthopedic follow-up in 2 weeks.
b. Surgical repair of the ankle with intramedullary rod placement in the fibula.
c. Surgical repair of the ankle, non-weight-bearing status for 9-12 weeks.
d. Ankle reduction in the ER, non-weight-bearing status, orthopedic follow-up in 6 weeks.
Filed under: Senior Report, Uncategorized