Ortho Case of the Week – Elbow, Ankle, and Jaw Dislocations ANSWERS

Case 1: A 24-year-old female BIBEMS for left ankle pain and deformity after tripping while stepping off a sidewalk.

Source: Radiopaedia

1. Describe your interpretation of the x-ray above.

Ankle dislocation with complex, comminuted, severely displaced fractures of the medial and lateral malleoli.

2. How would you reduce this?

1. Bend the knee to 90 degrees.
2. Plantarflex the foot.
3. Apply axial traction to the foot with an assistant holding countertraction.
4. Apply lateral traction proximal to and medial pressure distal to the injury.

3. How would you manage this patient after reduction? How would you immobilize them?

Apply a 3-sided short leg splint.

PLUS

Case 2: An 18-year-old male BMT presents with left elbow pain and deformity after tripping and landing on his outstretched hand during land nav.

Source: Radiopaedia

4. Describe the x-ray above.

Posterior elbow dislocation, without associated fracture.

5. How would you reduce this?

Likely will require sedation.

1. Have the arm supinated and in 30 degrees of flexion.
2. Provider applies traction to the distal forearm while a second provider holds countertraction to the humerus.

6. How would you manage this patient after reduction? How would you immobilize them?

Patients should be immobilized in a long arm posterior splint (video) with orthopedic follow-up in one week.