1. Ballarat EMET Hub Cases
Ankle injury
Ballarat EMET Hub
Cases

2. History 24 yo male, injured ankle at footy
Jumped for mark and landed badly
Deformed ankle, taken to a regional Hospital
What is immediate management in ED? And how is this done?

3. What action is required?

4. Do I have to reduce it? Yes This is a very unstable injury
Therefore it is actually very easy to reduce
Traction, return ankle to 90 degrees
Some nitrous and opiate such as fentanyl is a safe combination if concerned re over sedation post reduction (when reduced pain is massively reduced)
E.g Fentanyl reversed with Naloxone PRN
Nitrous oxide is short acting

5. That looks a lot better…

6. Management Deformity was reduced under anaesthetic / sedation.
Back-slab applied
Post reduction Xray showed:

7. Xray

8. Report
X-RAY RIGHT ANKLE    There is marked talar shift with widening of the   syndesmosis and some associated Weber A comminuted right     distal fibular fracture, extending supereolaterally by       approximately 65mm proximal to the ankle joint. The talar    dome appears to be intact.    

9. Ongoing management
Patient then transferred to Ballarat for orthopaedic R/V and definitive care