One-Stop Pain Control for Trimalleolar Fractures

​The incidence of all ankle fractures is about 187 cases per 100,000 people each year. Trimalleolar fractures occur in seven to 11 percent of those cases. (Orthop J Sports Med. 2019;7[11 Suppl 6]; https://bit.ly/3eQ4lRl.) Trimalleolar fractures involve the lateral and medial malleolus and the distal posterior aspect of the tibia (sometimes called the posterior malleolus).These fractures are serious and often unstable. They typically but not always need urgent or even emergent surgery. Often, they are reduced with a closed reduction prior to surgery. We suggest using a hematoma block to assist with pain control during initial stabilization and management before surgery. These fractures also should be treated with gentle relocation and splinting or casting until orthopedics can intervene.The CaseA 32-year-old man presented to the emergency department after dancing in the rain with a chief complaint of left ankle pain and swelling. Radiographs revealed a worrisome trimalleolar fracture. Trimalleolar fracture of the left ankle in a 32-year-old man approximately 24 hours after injury. Image by M. Roberts.Imaging: X-ray or CT?Patients with these injuries may be limping, although these fractures are quite painful and most cannot bear weight. Anterior and posterior lateral and oblique views of the ankle should be ordered. Once a fracture is identified, it is suggested that you also obtain foot and lower leg films to ensure no other fracture is present.Advanced imaging ...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs