Posted: Sep 12 2020 #(C101581)

Hawkins III Talar neck fracture dislocation with a medial malleolus fracture

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HPI

28F involved in a head on motor vehicle collision with closed injury to her right ankle. Unable to ambulate from cite of collision secondary to ankle pain.

PMH

None

MSK - RLE - skin intact, NVID. Fullness present to posteromedial ankle with body of talus palpable subcutaneously. Ankle without undue swelling, skin wrinkles present.

Poll

1 of 8

What additional imaging studies would you obtain to guide treatment?

1 None - Current radiographs are sufficient

2 Additional xrays

3 CT of the foot and ankle

4 MRI of the foot and ankle

5 Additional xrays + CT

6 Additional xrays + MRI

7 CT + MRI of the foot and ankle

8 Additional xrays + CT + MRI

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

Other

Submit

P: 120257

Would you use a classification system to guide management?

1 No - a classification system would not help me

2 Yes - Hawkins

3 Yes - AO/OTA

4 Yes - Other

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

Other

Submit

P: 120258

How would you manage this injury?

1 Nonoperative

2 Operative

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

Other

Submit

P: 120259

If you choose Operative management, when would you perform surgery?

1 I would not choose Operative management

2 Emergently (within 2-3 hours)

3 Urgently (within 4-6 hours, I would NOT wait until following morning)

4 Semi-urgently (within 7-12hrs, first case following morning)

5 Routinely, within 13-24 hours

6 Routinely, within >24 hours

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

Other

Submit

P: 120260

If you choose Operative management, how would you obtain your reduction?

1 I would not choose Operative management

2 Planned Closed reduction

3 Planned Open reduction

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

Other

Submit

P: 120261

If you choose Closed Reduction, would you also supplement with any internal fixation?

1 I would not choose Closed Reduction

2 No

3 Yes - percutaneous pinning

4 Yes - percutaneous screws

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

Other

Submit

P: 120262

If you choose to supplement Closed Reduction with Internal Fixation, would this serve as your definitive fixation?

1 I would not choose Closed Reduction with internal fixation

2 Yes

3 No - I would plan on subsequent ORIF

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

Other

Submit

P: 120263

If you choose to perform a subsequent open reduction internal fixation (ORIF), when would you plan to proceed with surgery?

1 I would not choose to perform perform a subsequent open reduction internal fixation (ORIF)

2 < 1 week

3 1-2 weeks

4 >2 weeks

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

Other

Submit

P: 120264

Intra-procedure P1

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