The Perils of Bike-Riding While Drunk

​As this young man found out, it is not wise to ride a bike across trolley tracks at night while intoxicated. It's not shocking that he complained of ankle pain. With the deformity apparent, the trimalleolar fracture with lateral dislocation hardly needed an x-ray to tell us where we were headed. The radiology tech documented the devastation while we rounded up the necessary supplies.I think a four-person team event tends to give the best results: one to give pain medication or sedation and to observe the patient's status, two to splint the leg (one to hold and one to wrap), and one to hold the toes. I always choose the toes. Not only can I watch the patient and the monitor, but I also likely have the best chance at making an awesome reduction.The ligaments are already shot, so picking up the leg by the toes tends to allow the weight and gravity to bring everything back in place. The great toe needs to be pointed at the ceiling and in line with the patella. Hold the leg by the toes until a sugar tong and a posterior tibial splint are placed.  Take-Home Points:To get a great reduction, tilt the odds in your favor with enough people to help, and use the weight of the leg to your advantage.Afterwards, don't forget ice, elevation, and neurovascular checks.Tags: ankle, trimalleolar fracture, lateral dislocation, sugar tong, posterior tibial splintPublished: 8/1/2016 8:48:00 AM
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs