SAQ 76 – Orthopaedics – open ankle injury management
Model Answer
Question 9. open ankle injury management.
a. First 20 minutes of management. (10 marks)
| Management step | Detail |
|---|---|
| Analgesia. | IN fentanyl 100 mcg or IM ketamine if IV access is not yet available; IV morphine 5 mg then titrate to pain, BP, RR, and GCS. |
| Sedation. | IV midazolam 2 mg in titrated aliquots, noting the patient is not fasted. |
| Reduction. | Longitudinal traction with varus force, followed by repeat X-ray. |
| Splint and wound care. | Back slab plus U-slab; non-adherent dressing over the wound. |
| Antibiotics and tetanus. | Cefazolin 1 g IV and ADT 0.5 mL IM. |
| Orthopaedic referral. | For definitive washout and ongoing operative management. |
b. Acute complications requiring urgent surgery. (4 marks)
- Ischaemic foot from injury or kinking of the anterior tibial, posterior tibial, or dorsalis pedis artery.
- Inability to disimpact or reduce the fracture.
- Neuropraxia or acute neurovascular compromise.
- Compartment syndrome.
- Uncontrolled haemorrhage.
- Gross contamination of the wound.
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