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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month - February 2019

This 24 year old male presented to the ED with ankle pain after an eversion injury sustained while playing basketball.

Question 1 : What would you call this fracture?
Question 1 X Ray 1

Question 1 X Ray 2

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Answer 1:

This is a trimalleolar fracture – called so because it involved fracture of the medial and lateral malleoli PLUS a fracture of the posterior distal tibia (which in this case is called the posterior malleolus.)

See images below for another patient of ours who had an isolated posterior malleolar fracture (which is much easier to visualize!)

Question 1 X Ray 1
Question 2 : What is the first thing you should do for this patient after determining that he is stable and has no other dangerous injuries?

View answer
Answer 2:

It is crucial to assess for neurovascular compromise of the foot. The ED provider should check dp and pt pulses (compare to other side), sensory and motor function, cap refill, color and temperature before sending the patient to x-ray. He was reported by EMS for have a weak pulse. If this finding were confirmed (which in this case it was not), he would most likely need emergent reduction performed prior to imaging.

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