EM Forum Case #149 "Don’t Miss What
You Can’t See, So Splint Liberally!"
by Charlene Babcock Irvin, MD, FACEP
A 38 y/o morbidly obese female presents with
leg pain after a fall. She appears
comfortable, with her left ankle resting on
a pillow.
When asked what happened she
tells you she dislocated her ankle when she
fell down the steps. You immediately examine
the ankle and note it is not dislocated, and
has a strong dorsal pedis pulse.
Back to
more history: She describes mis-stepping on
the top of 12 carpeted steps, and then
landing on her buttocks, and sliding all the
way to the bottom with her left leg behind
her. When asked where it hurts, she points
to the ankle.
She did not strike her
head, abdomen, chest, neck or any other
location except her buttocks. She only has
pain in the ankle, but she notes the pain is
much better after the paramedics gave her a
pain shot.
PMH/ FH/ SH: Unremarkable
PE: Obese (350 lbs) female, cooperative,
in no acute distress.
HEENT: Normal,
no C-spine tenderness. Chest, Abd, pelvis,
all normal.
T/spine and L-S spine
are non-tender. No coccyx tenderness.
No femur pain, but she does have some
medial mild tenderness to the medial portion
of the knee. The ankle is tender anteriorly
and laterally over the lateral malleolus,
and the foot has tenderness at the 5th
metatarsal.
Questions:
1. Which ligament is usually involved in an
ankle sprain? Which ligament is the
strongest?
2. How are ankle sprains
graded?
3. What is snowboarder’s
fracture?
Click here for answers and to respond
