Open Subtalar Dislocation in 32M

HPI

Patient is a 32 year old male who presents to the trauma bay after MVC traveling approximately 50mph. Accident occurred less than 1 hour ago. Upon arrival to the trauma bay, the patient was found to be hemodynamically stable and complaining of severe right ankle pain. Patient denies pain in any other extremity. No head trauma, loss of consciousness or altered mental status.

PMH

no significant past medical history

PE

Gen: alert, oriented x 3, appropriate mood and affect, moderate distress 2/2 pain   BUE- sensation intact to light touch in radial, median, axillary, and ulnar nerve distributions. Capillary refill time brisk, radial and ulnar pulses palpable. Motor function intact to biceps, triceps, wrist flexors and extensors. No open wounds or gross deformities. Compartments soft to palpation. RLE: Gross open deformity present Sensation intact to light touch grossly. DP pulse dopplerable but not palpable, PT pulse not dopplerable or palpable. Capillary refill time brisk. Able to extend toes. Transverse laceration over medial and posterior ankle with exposed talar head and plafond, as well as multiple tendonous structures. No active bleeding from posteromedial ankle.   LLE- No gross deformity. No tenderness to palpation. No block to ROM at hip/knee/ankle. Sensation intact to light touch in sural, saphenous, superficial peroneal, deep peroneal, and tibial nerve distributions. Intact TA/GS/EHL function. Palpable DP/PT pulse.