Ankle Injuries

Remember analgesia.Always assess and record the patient's ability to bear weight

Ankle sprains - Ottawa Ankle Rules

Ankle x-rays are required only if criteria below are fulfilled.

With apparent ankle injuries, check other sites of trauma which are easily missed (i.e. tendo-achilles, os calcis, base of 5th metatarsal, whole of fibula (and tibia)
Remember to x-ray the foot if there is bony tenderness over the navicular or base of 5th metatarsal
Check for AP instability
Treat by ice (if recent), elevation and active exercises when elevated
Encourage weight bearing, [BestBets] give stick/crutches if necessary
In the case of a bad sprain, the above treatment is best supervised by direct referral to physiotherapy.

If undisplaced, treat with below-knee POP and refer to the Fracture Clinic (CUH Fracture Clinic Referral form)
Consider prophylactic anticoagulation (LMWH) if high risk of VTE or prior DVT.[BestBets]
CUH EM and Orthpaedic divisions have (Feb 2013) reviewed the literature (including the 2012 Oct CEM guideline). Prophylactic anticoagualtion is not required those pateints discharged in a backslab
If displaced or tibio-fibular diastasis, refer to the on-call Orthopaedic Team
If diastasis, obtain X-ray of whole leg

SH 3 (saLtr) # distal tib. / tibiofibular lig
12-14 yo, rotation / inversion injury (epihpysis matures from med to lat)
Swollen⁺, NWB, x-ray may be subtle
Check (clinical and x-ray) prox fibula in case of Maisonneuve # (peroneal nerve)
Often need ORIF (displacement >2mm)

Consider prophylactic anticoagulation (DOAC) if high risk of VTE or prior DVT.[BestBets]
All patients immobilised for lower limb trauma should be given written advice on their increased risk
CUH EM and Orthpaedic divisions have (Feb 2013) reviewed the literature (including the 2012 Oct CEM guideline). Prophylactic anticoagualtion is not required those pateints discharged in a splint but should be considered in all in PoP