A
28 year old male / female, came to me because of pain in her right ankle since 2
days. Patient was brought in wheel chair / came walking with limp. Injury due to
twisting of the foot and ankle due to slip on the steps / fall while walking on
irregular surface. Initially mild to moderate pain and increased gradually. Aching
pain. Pain is continuous and more on walking. Mild swelling around anterior and
lateral ankle. Pain increasing with weight bearing. Radiation to the anterior and
lateral foot. No ecchymosis. No color change. No fever. No significant family
History. Social History -Employed. No chronic disease or known allergy. All other
systems reviewed and are negative
On examination of ankle:
Conscious and coherent patient who came in wheelchair / limping with antalgic
gait. On examination there was tenderness over and below the anterior and
lateral malleoli. Moderate oedema present. No tender ecchymosis. Restricted
ROM. Talar tilt test and Fibular compression test / Squeeze test –positive. External
rotation test and modified kleiger test – negative. Anterior drawer test is painful.
No deformity. No crepitus. No abnormal mobility. No redness. No raise of
temperature. Active toe movements present. Distal pulses felt
Pain & swelling of the left ankle after a Hx of twisting of the foot while playing in
school yesterday
The child is limping; Swollen Lt ankle & foot; Mild tenderness upon palpation of
the Lt medial malleolus; Mild limitation of the range of motion due to pain
Explained about the preliminary differential diagnoses and initial workup plan to
the patient.
X-ray: NAD
Impression: Acute sprain of calcaneofibular ligament left ankle
Later explained about the X-ray result, probable diagnosis. Explained about the
treatment options and its complications. Parents were convinced about the
management plan.
Plan:
Short leg splinting
Analgesics
Rest / SL 1 day
Non-weight bearing
Hot water fermentation/ ice wrapped the pack in a towel and apply for 15-20
minutes, 3 times daily.
Elevation of the limb
Patient needs were assessed, there was no educational barrier. Patient received education on potential
interactions, between prescribed medications and other medications (including over the counter
medications) and also food.
If any increasing pain / swelling or discoloration- back to ER
Possible complications discussed in details including joint stiffness & growth
disturb.
Strapping –Ankle and foot
Indication: Reduce movement
Location: Ankle and foot
Pre-Post Procedure Diagnosis: sprain and strain ankle and foot
Informed consent was obtained before procedure started.
Description:
Informed consent was obtained before procedure started. A non-medicated strap
applied from above the ankle to the toes in figure of 8 after applying soft roll for
the purpose of providing structural support, immobilization and compression for
the ankle and foot. Active toe movements advised. Elevation of the limb advised.
Short leg cast
Informed consent was obtained before procedure started.
Description:
Immobilization by application of cast constructed from the toes to ankle. Patient
tolerated procedure well. Advised elevation and monitoring of fingers for
discoloration, swelling or increased pain and to report back to clinic asap if
happened. All instructions related to fracture and care of cast were given.
Analgesia
Sick leave
RICE
Short leg Splinting
Informed consent was obtained before procedure started.
Description:
Immobilization by application of backslab with scoth cast after applying stoicknet
and soft roll constructed from the toes to ankle in functional position. Patient
tolerated procedure well. Advised elevation and monitoring of fingers for
discoloration, swelling or increased pain and to report back to clinic asap if
happened. All instructions related to fracture and care of cast were given
