Ankle fractures March 2018 | by EMauthor Unimalleolar fractures •Undisplaced, below knee back slab. Crutches and fracture clinic follow up •Displaced or with talar shift, refer to orthopaedics •Remember the Maisonneuve fracture, it requires surgery, refer Bimalleolar and Trimalleolar fractures •Correct any gross deformity before or after x-ray •Temporary back slab splint •Refer to orthopaedics Fracture/Dislocation of ankle •There is serious risk of necrosis of stretched skin •Reduce dislocation urgently (usually) before sending to x-ray with iv analgesia/sedation, the aim is primarily to relieve the pressure on the skin •Check pedal pulses before and after reduction •Apply temporary back slab splint and then x-ray •Refer to orthopaedics urgently Key point: alignment does not have to be perfect: it is to reduce the risk of necrosis of stretched skin. Re-sedating a patient is a considerable risk and should be avoided. Avulsion fractures of malleoli •Analgesia •Walking stick or crutches •Fracture clinic follow up and consider (psychological) Tubigrip |
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