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.
Malleolar fractures
- 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
Tillaux #
- SH 3 (saLtr) # distal tibia / 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 (beware displacement >2mm)
Thromboprophylaxis
In patients immobilised in leg casts:
- 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 splint but should be considered in all in PoP
Links
- IAEM Policy on Thromboproplylaxis in lower limb injuries 2019
- Thromboprophylaxis in lower limb immobilisation after injury (TiLLI). EMJ Journal Jan 2020, 37 (1) 36-41; DOI: 10.1136/emermed-2019-208944. Thromboprophylaxis in lower limb immobilisation after injury (TiLLI) Daniel Horner1,2, Steve Goodacre2, Abdullah Pandor2, Timothy Nokes3, Jonathan Keenan3, Beverley Hunt4, Sarah Davis2, John W Stevens5, Kerstin Hogg6 1Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK 2Centre for