Ankle Fracture-Dislocation with Syndesmotic Disruption and Medial Widening in 27Y

HPI

A 27-year-old male presented to the emergency department in the early morning hours after sustaining a rotational injury to his right ankle while leaving a bar. He reports immediate onset of severe pain, visible deformity, and inability to bear weight on the affected extremity. Injury films at presentation are shown. Two attempts at closed reduction were performed and post reduction films shown. The first attempt restored the posterior translation; however, persistent widening of the medial clear space was noted. A second reduction attempt was unsuccessful.

PMH

No known medical conditions.

PE

Examination of the right ankle demonstrates a gross deformity with marked swelling and diffuse tenderness. There are no open wounds. The patient is unable to bear weight. Distal pulses are palpable, and capillary refill is less than 2 seconds. Motor and sensory function are intact distally. The patient is alert and oriented, in significant pain.