Posted: Oct 30 2021 #(C101836)

Trimalleolar Ankle Fracture in 64F

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HPI

This is a 64 year old female that presents to the ED after a ground level fall and twisting her right ankle. She states that she heard a crack and was unable to ambulate afterwards. She denies any pain in any other extremity.

PMH

obesity, hyperlipidemia, hypertension

Focused physical exam of the left lower extremity reveals diffuse swelling about the ankle. Tenderness to palpation diffusely and pain with active and passive range of motion. Sensation and motor are intact distally and 2+ pulses present in the foot.

Poll

1 of 10

In addition to the radiographs provided, would you obtain any further imaging to guide your management?

1 No - Current radiographs are sufficient

2 Yes - additional radiographs (aXR)

3 Yes - CT scan

4 Yes - MRI

5 Yes - aXR + CT

6 Yes - aXR + MRI

7 Yes - CT + MRI

8 Yes - aXR + CT + MRI

9 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138506

Would you use a classification system for this injury to guide management?`

1 No - a classification system would not help me

2 Yes - AO/OTA

3 Yes - Lauge-Hansen

4 Yes - Danis-Weber

5 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138507

How would you definitively manage this patient?

1 Non operatively

2 Operatively

3 Beyond my scope of practice, prefer not to answer

Other

Submit

P: 138563

If you choose Operative management, what technique would you use for definitive management?

1 I would not choose Operative management

2 External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)

3 Closed reduction and percutaneous pinning (CRPP)

4 Open reduction internal fixation (ORIF) (includes plate, screws, wires, minimally invasive plate)

5 Arthrodesis

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138564

If you choose Open reduction and internal fixation (ORIF), which fractures would you fix?

1 I would not choose Operative management

2 Lateral malleolus only

3 Medial Malleolus only

4 Posterior Malleolus only

5 LM + MM

6 LM + PM

7 MM + PM

8 LM + PM + MM

9 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138565

If you choose Open reduction internal fixation (ORIF) of the LM + PM + MM, would you address the PM or LM first?

1 I would not choose Operative management

2 Fibula

3 Posterior malleolus

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138567

If you choose Open reduction and internal fixation (ORIF) of the LM + PM + MM how would you stabilize the PM?

1 I would not choose Operative management

2 Indirectly with A-to-P screw(s) only

3 Directly with P-to-A screw(s) only

4 Directly with Plate and screws

5 Indirectly with Syndesmotic fixation

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138568

If you choose Open reduction internal fixation (ORIF) of the LM + PM + MM, which construct would you use to address the MM?

1 I would not choose Operative management

2 Tension band with K-wires

3 Single partially threaded cancellous lag screws (lag by screw design)

4 Two partially threaded cancellous lag screws (lag by screw design)

5 Single bicortical fully threaded lag screw fixation (lag by method)

6 Two bicortical fully threaded lag screw fixation (lag by method)

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 138569

If you choose Operative management and attained the construct shown below, how long would you keep the patient non-weightbearing post-operatively?

1 I would not choose Operative management

2 <2 weeks

3 2-4 weeks

4 4-6 weeks

5 6-8 weeks

6 8-10 weeks

7 10-12 weeks

8 greater than 12 weeks

Other

Submit

P: 138570

Intra-procedure P1

Post-procedure P1

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