Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Ankle Fractures
Posted: Dec 19 2020 #(C101682)
A

Ankle Fracture in 26F

HPI

A 26-year-old female presents to the ED for a left ankle injury she sustained while playing soccer. The patient reports she was challenging another player for the ball when they collided causing her to injure her left ankle. She fell to the ground and had immediate pain and deformity. She was unable to ambulate. She denies numbness, tingling, or other injuries.

PMH

None

PE

On focused exam of the LLE she has obvious deformity to the left ankle. No open wounds or abrasions. Her PT pulse is palpable. She has BCR in all toes. She is able to wiggle her toes, but we did not attempt to dorsiflex or plantarflex her ankle.  Her sensation is intact to all distributions of the foot.

Poll
1 of 11
1. In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
24%
420/1708
Yes - additional radiographic views (aXR)
0%
17/1708
Yes - CT
65%
1119/1708
Yes - MRI
1%
18/1708
Yes - aXR + CT
4%
79/1708
Yes - aXR + MRI
0%
4/1708
Yes - CT + MRI
0%
17/1708
Yes - aXR + CT + MRI
0%
7/1708
Outside my area of expertise - best if I don't vote
1%
27/1708
2. Would you use a classification system for this injury to guide management?
No - a classification system would not help me
26%
430/1622
Yes - Lauge-Hansen
34%
559/1622
Yes - Danis-Weber
19%
320/1622
Yes - AO/OTA
13%
227/1622
Yes - Other
1%
25/1622
Outside my area of expertise - best if I don't vote
3%
61/1622
3. How would you manage this injury?
Nonoperative
0%
14/1650
Operative
98%
1619/1650
Outside my area of expertise - best if I don't vote
1%
17/1650
4. If you choose Operative management, would you discharge the patient and perform later as an outpatient or admit for acute fixation?
I would not choose Operative management
0%
8/1616
Discharge patient and perform later as Outpatient surgery
31%
504/1616
Admit for acute fixation
67%
1087/1616
Outside my area of expertise - best if I don't vote
1%
17/1616
5. If you choose Operative management, what technique would you use?
I would not choose Operative management
0%
2/1631
External fixation (ExFix) (includes monoplane, circular fixation)
1%
32/1631
ExFix + Limited internal fixation (percutaneous screws)
1%
30/1631
Open reduction internal fixation (ORIF)
94%
1534/1631
Primary arthrodesis
0%
5/1631
Outside my area of expertise - best if I don't vote
1%
28/1631
6. If you choose ORIF, which fractures would you plan to fix?
I would not choose ORIF
0%
1/1521
Medial malleolus (MM) only
0%
9/1521
Lateral malleolus (LM) only
0%
12/1521
Posterior malleolus (PM) only
0%
3/1521
MM + LM
51%
790/1521
MM + PM
0%
15/1521
LM +PM
1%
22/1521
MM + LM + PM
42%
649/1521
Outside my area of expertise - best if I don't vote
1%
20/1521
7. If you choose to include ORIF of the medial malleolus (MM), what type of implant would you utilize?
I would not choose ORIF of the MM
0%
1/1555
Single cannulated screw
8%
125/1555
Two cannulated screws
52%
812/1555
Single solid screw
3%
52/1555
Two solid screws
15%
240/1555
Tension band with k-wires
10%
169/1555
Hook plate
7%
112/1555
Outside my area of expertise - best if I don't vote
2%
44/1555
8. If you choose to include ORIF of the medial malleolus (MM) with 1 or 2 cannulated or solid screws, would you try to obtain bicortical screw purchase?
I would not choose ORIF with screws of the MM
1%
27/1419
No - I would Not obtain bicortical purchase
71%
1009/1419
Yes - Bicortical purchase with 1 of 1 screw
3%
46/1419
Yes - Bicortical purchase with 1 of 2 screws
9%
129/1419
Yes - Bicortical purchase with 2 of 2 screws
11%
163/1419
Outside my area of expertise - best if I don't vote
3%
45/1419
9. If you choose to include ORIF of the medial malleolus (MM) with 1 or 2 cannulated or solid screws, would you use a percutaneous approach or make an open incision and visualize/reduce the fracture?
I would not choose ORIF with screws of the MM
1%
26/1405
Screws with Percutaneous Approach of MM
10%
147/1405
Screws with Open Visualization and Reduction of MM Fx
85%
1208/1405
Outside my area of expertise - best if I don't vote
1%
24/1405
10. If you choose ORIF and attained the construct shown below, when would you initiate weight bearing?
I would not choose ORIF
0%
0/1447
< 2 weeks
4%
70/1447
3-4 weeks
18%
262/1447
5-6 weeks
51%
744/1447
7-8 weeks
19%
286/1447
9-12 weeks
3%
57/1447
>12 weeks
0%
13/1447
Outside my area of expertise - best if I don't vote
1%
15/1447
11. If you choose ORIF and made the patient non weight bearing after surgery, what DVT prophylaxis would you prescribe?
I would not choose ORIF
0%
4/1483
None
15%
231/1483
Aspirin
28%
427/1483
Low molecular weight heparin (lovenox)
39%
582/1483
Heparin
4%
73/1483
Xa inhibitors (xarelto etc.)
9%
142/1483
Other
0%
7/1483
Outside my area of expertise - best if I don't vote
1%
17/1483
PROCEDURE #1

Left ankle ORIF

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options