Date post: | 01-Jan-2016 |
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19 yo male wth no significant PMH comes in to ED s/p texting while on a pogo stick and sustaining a fall. Patient has an obvious ankle deformity.
Ankle Inspection Palpate base of 5th metatarsal (Jones, Dancers)
Palpate navicular
Palpate Achilles tendon and do Thompson test (Achilles rupture)
Palpate bony prominences (medial and lateral malleoli)
Palpate proximal fibula (Maisonneuve)Think referred pain -see reference 1
Things to Do Antibiotics and tetanus
XR
Remove gross contamination and apply moist sterile dressing
Photograph
Reduce/Splint the limb
Arrange for urgent surgical debridement/washout and stabilization of the fracture
Gustillo Type III - extensive damage to soft tissue and high degree
of contamination and a great deal of communtion and instability
Antibiotics Gustillo I and II
- 1st generation cephalosporin (Ancef)
- if allergy: clindamycin or vancomycin
Gustillo III - in addition to above add an aminoglycoside
(Gentamycin)
If a farm injury or open bowel contamination - add penicillin (to cover clostridium)
Pearls Six Hour Golden Rule
Orthopedic goal to have operative repair of open fracture within 6 hours