SAQ 228 – Orthopaedics and Ethics – ankle fracture-dislocation, analgesia, and privacy

Question 8. ankle fracture-dislocation, analgesia, and privacy.

a. X-ray findings

• Comminuted distal-fibula fracture, Weber C.
• Disruption of the distal tibiofibular syndesmosis.
• Medial-malleolar fracture.
• Lateral subluxation of the talus.

b. Analgesia issues

• Alcohol intoxication increases risk of hypotension and reduced GCS.
• Buprenorphine may cause relative resistance to IV opioids and higher doses may be required.
• Close observation is required after IV analgesia.
• Use titrated IV opioid or ketamine boluses.
• Prompt splinting, reduction, and elevation reduce analgesic requirements.

c. Privacy techniques

• Use an alias or de-identify the patient in the electronic system.
• Use a cubicle in a discreet area and keep the door or curtain closed.
• Limit knowledge and discussion of the patient's presence to directly involved staff.
• Notify the media liaison officer if required.
• Expedite care without compromising other patients.
• Reinforce staff privacy obligations.