SAQ 359 – Orthopaedics – open ankle fracture-dislocation
Model Answer
Orthopaedics – open ankle fracture-dislocation.
a. Photograph abnormalities
- Open fracture-dislocation of the left ankle.
- Profound displacement, approximately 90 degrees external rotation.
- Large contaminated wound.
- Minimal active bleeding.
- Left calf flap wound.
b. Assessment priorities
- Identify life-threatening injuries with primary survey.
- Assess the limb neurovascular status, including pulses/Doppler, and define bony anatomy with X-ray.
- Obtain AMPLE history: allergies, medications, past history, last intake, and event details.
c. Management
- Analgesia with titrated IV fentanyl with or without low-dose ketamine.
- Broad-spectrum IV antibiotics and tetanus prophylaxis; this is consistent with a Gustilo-Anderson type III injury.
- Gross wound decontamination with warm saline wash.
- Reduce the fracture-dislocation under sedation, immobilise, and reassess neurovascular status.
- Admit for orthopaedic operative washout/fixation; involve vascular surgery urgently if vascular compromise persists after reduction.
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