Case 4 - 19 yo female sports injury

Question 1

Compartment syndrome

Answer 1

• serious life and limb-threatening complication of severe trauma
• rising pressure in a muscle compartment impairs perfusion
• rx: fasciotomy
• S/s: 6Ps: pain, pallor, paresthesia, pulselessness, poikilothermia, paralysis

Question 2

History for ankle injury

Answer 2

acute or chronic?
mechanism of injury
most common ankle injury: plantarflexion and inversion

Question 3

Lower extremity physical exam

Answer 3

• first inspect, then palpate pulses, check for edema, test motor, test gait, joint stability
• test anterior drawer test for anterior talofibular ligament stability
• inversion test - check for calcaneofibular ligament

Question 4

Grading Ankle Sprains

Answer 4

Grade I - stretching and/or small teat of ligament, slight to no functional loss, mild tenderness and swelling, no ecchymosis, no instability
Grade 2 - incomplete tear, moderate functional impairment, difficulty bearing weight, tenderness over involved structures, mild to moderate swelling, ecchymosis common, moderate instability
Grade 3 - complete tear, inability to bear weight, severe swelling, mechanical instability

Question 5

Differential diagnosis for ankle swelling

Answer 5

1. Ankle sprain - most common acute ankle inury
2. Peroneal tendon tear - can occur in conjunction with ankle sprain
3. Talar dome fracture
4. Fibular fracture - usually due to high velocity mech
5. Tendonitis - inflammatory, usually not this acute
   6 Subtalar injury - usually high-energy
   Less likely: tarsal tunnel syndrome, syndesmotic injury, infection of the joint, arthritis of the ankle, tibial fracture of the tibia, pathologic fracture, achilles tendon rupture

Question 6

The Ottawa Rules

Answer 6

Radiographs of ankles are needed if:
- pain in malleolar zone or bony tenderness along posterior edge of malleolus or inability to bear weight both immediately and in ED
Radiographs of foot are needed if: pain in midfoot, bony tenderness at navicular bone or inability to bear weight both immediately and in ED

Question 7

Management of ankle sprain

Answer 7

1. RICE - rest, ice compression elevation
2. Anti-inflammatories
3. Daily ankle exercises
4. avoid potential re-injury

Question 8

Management of dysuria

Answer 8

• bactrim can be used for empiric treatment of uncomplicated UTI with no sulfa allergy
• cipro can be used if resistant to bactrim