72 surg orth sprained ankle

8/18/2019 72 Surg Orth Sprained Ankle

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Information Sheet for Candidates

Your next patient in a suburban emergency

department is a 20 year old basketball player, John.

He injured his right ankle during a basketball gameyesterday, when he ‘dunked a ball and coming down

he twisted his ankle. His !oot turned inwards

underneath him and because o! "uite se#ere pain he

stopped playing. $arked swelling appeared on the

lateral side o! the ankle but with ice treatment by the

trainer and resting the !oot , the swelling has gone

down although it is still sore to walk on the !oot.

Your task is to:

• %er!orm an examination &tell the patient what

you are doing'(

• )xplain your !indings and the most likely

diagnosis to the examiner • )xplain your management plan to the patient


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EXAMINATION: (LOOK, LISTEN, EEL !!!!":

*r inspection + mo#ement testing + palpation'-%)/*-1

welling, de!ormity, bruising, old scars, gait !or possible limping

John has a slight limp because o! pain on lateral side o! ankle'

$*)$)- &3/) 3-4 %3)'(15lexion, extension &dorsi!lexion(, in#ersion, e#ersion, circular mo#ement.

John complains about pain on plantar !lexion and in#ersion

%36%3*- &start on non tender side'(1

enderness, e!!usion. pecial attention to bony prominences like medial and lateral

malleolus and base o! !i!th metatarsal &*ttawa rules'(.

6igaments1$)4361 7deltoid ligament8

63)9361 anterior talo!ibular ligamentcalcaneo!ibular ligament

posterior talo!ibular ligament

ibio!ibular ligament'73nterior draw sign'8

John is tender o#er the anterolateral area &anterior talo!ibular ligament area'(

7*3:3 3-;6) 9


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@934) 1 partial tear, usually o! anterior talo!ibular ligament, little swelling, pain on

mo#ement, normal 9*$, tenderness next to the tip o! the malleolus.

@934) 1 pain at rest, limited weight bearing, moderately se#ere localised pain andswelling, calcaneo!ibular ligament usually in#ol#ed, tenderness directly

in!erior to malleolus, mild to moderate instability

@934) 1 complete tear o! two or more ligaments, se#ere pain, immediate swelling, joint mo#ement with 3% stressing &anterior draw test(, ankle

reconstruction recommended'

$3-3@)$)-1#: rest !or AB hours with early mobilisation with short term use o! crutches

depending on extent o! injury, when able to weightbear com!ortably then walk,

when able to walk com!ortably then run, when able to run, then twist and turn, physiotherapy re!erral, consider ‘wobble board.I: cold therapy with co#ered ice packs &not directly on skin'( !or about 20 minutes e#ery C+A hours asoconstriction and reduces in!lammation(

C: compression bandage

E: ele#ation

#: re#iew in AB hours, then D days

S: special strapping, especially i! early return to sport re"uired

$%ESTIONS:

E:hen can go back to playing basketball againE 1 C+? weeks with support, depending

on extent o! injury.

E/an dri#e my carE1 -ot !or about a week, to allow rest and healing'

E4o need crutchesE Yes, !or the !irst two days and perhaps e#en longer depending onextent o! the injury.

72 surg orth sprained ankle

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