Ankle sprain

Question 1

A 16 year old man presents with a painful ankle after a fall playing football. There is marked swelling of the ankle, and tenderness below the lateral malleolus. X-Rays are negative. How would you manage him?

Answer 1

Impression
Ankle sprain. Concerned about ruling out fractures and neurovascular compromise.

DDX injuries to consider
- Notably, neg X-Ray doesn’t rule out fracture in acute setting of inflammation and swelling
- Ligament: deltoid rupture, ATFL, PTFL injuries, ankle syndesmosis (high ankle sprain)

Goals
- Thorough Hx/Ex/Ix, utilise Ottawa ankle rule for clinical decision making
- appropriate referral for definitive treatment

Question 2

Ankle sprain - History

Answer 2

History
- sx: pain (SOCRATES; malleolus/ankle pain vs mid-foot pain), timing, MOI (twisting, direct blow, etc), severity
- Treatments administered, current analgesia onboard
- PMHx: previous ankle injuries, previous surgeries
- Medications, allergies, last meal

Question 3

Ankle sprain - Examination

Answer 3

Examination
- General appearance + vitals
- Ankle exam - utilise Ottawa ankle rule
o inspection: gait (?weight-bearing), swelling, erythema
o palpation: tenderness (LOCATION)
- assess joint above and below

Question 4

Ankle sprain - Investigations

Answer 4

Investigations
Key
- ankle X-Ray pending Ottawa ankle rule decision
Grade the severity
1
2
3

Other
- pre-op bloods: FBC, UEC, G+H

Question 5

Ankle sprain - Management

Answer 5

Management
Depends on nature of injury (Degree of fracture): fracture vs soft-tissue injury
- Call ortho for review

Supportive
- RICE
- analgesia
- supported weight bearing
- physio referral for rehab and return to mobility/walking
- OT for casting/

Definitive
- Fracture: closed reduction vs ORIF and casting +/- cam boot
- may benefit from moon-boot as well for short period, refer to OT for fitting