EM Forum Case #103 "Courtside Consult"
by Charlene Babcock Irvin, MD, FACEP  

I was attending the father-daughter eighth grade basketball game when one of the fathers injured his ankle. He was helped off the court, and, being the only physician at the game (my daughter and husband were also playing) I was asked to come take a look.

I didn’t see the actual injury, but according to the injured dad (48 y/o) he came down on his ankle and it twisted. The pain was immediate. He was able to ‘hobble’ off the court with some assistance. He did not injure himself any other place.

On examination of the leg, he had no proximal fibular pain, and he had tenderness to the anterior talo-fibular ligament insertion (on the talus) with some minimal swelling (it was examined just after the injury, so no real time for swelling). He also had some diffuse tenderness posteriorly. There was no point boney tenderness to the distil tibia or fibula. When I asked him to stand and walk, he could walk 4 steps (hobbled, but was able to transfer weight). On testing his ligament stability, he had a negative drawers sign (no ligament instability), and inversion and eversion ligament testing was normal.

He asked, “Do you think I need to go to emergency for an x-ray?

And his wife adds: “Were supposed to leave for Florida next week, I hope he didn’t break his ankle.”

Questions:


1. What are the Ottawa Ankle Rules for radiographs of the ankle? Does he need one?

2. What test needs to be done to rule out an injury requiring surgery?

3. What is a jones fracture?

4. What is a Maisonneuve fracture?

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