June 2021: Will This Patient Need a New House?

​I love to test myself to see if I can guess what I am going to see with the minimum number of films. I played this game recently when looking at this man's knee film. He had been drinking and slipped walking down a set of stairs.With one glance and one film, I knew I had to order another film. The patient was distraught about his recent knee replacement. He was sure he had messed it up. He could barely contain his frustration that I went straight to his ankle. I explained about potential other injuries as I palpated the medial malleolus.He did not have much swelling, but I rationalized it away by thinking it might be too early. He had come in right after his fall, and the lack of pain could be discounted by the alcohol. I waited for the ankle films, and I was sure I would see a widened mortise and likely a medial malleolar fracture. My mind whispered, "You won't need to give this guy a new house."It wasn't what I expected! The fracture was on the wrong bone, but it did not violate the rule of the ring. I saw two fractures, just like when a ring is twisted to its breaking point. This is not unheard of in the literature. The Maisonneuve variant of a proximal and distal fibular fracture had been seen before. I wondered if I would have known before the film if I had examined the lateral malleolus more. Tip to Remember: When you see a proximal fibular fracture, think of the new house the patient may get if you don't image the ankle. This is the way you c...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs