2.  Patient is a 67 yo WF
with h/o HTN that
presents with left ankle
pain after an MVC. Pt
was restrained driver.
She slammed both feet
down on the break,
locking her legs, just
before the collision.
Now pt has obvious
deformity of left ankle
as well as severe pain.
 Vitals: T: 98.4, HR: 97, RR: 16,




BP: 108/64, POx: 97%
Gen: elderly white female
with left ankle deformity but
NAD
CV: RRR
Pulm: CTA B
MSK: left ankle has obvious
deformity with edema. Distal
part is dislocated laterally. 2+
pulses. Pt has sensation
intact. Good cap refill. No
open fx. TTP diffusely over
ankle

4. Tri-Malleolar fractures include a lateral malleolus fx(on left) , a medial malleolus
fx(on left), and a posterior malleolus fx(on right)

5.  Check Neurovascular status
 Reduce if necessary
 Splint in posterior leg splint with stirrups
 Bulky jones splint if significant edema
 Immediate orthopedic consult or transfer for definitive
care (ORIF)
 Appropriate pain management

6.  Can also be seen with a bi-malleolar fracture and
deltoid tendon rupture(instead of medial malleolus
fracture)
 Can take 6-12 weeks of recovery following ORIF
 Often associated with dislocation
 Is an unstable fracture requiring IMMEDIATE
orthopedic intervention

7. CT 3D reconstruction of
fracture
Tri-mallolar fracture after
surgical repair

8.  http://reference.medscape.com
 http://www.gentili.net/footanklefracture1.asp?ID=135
 http://www.laorthospecialists.com/AnkleFractures.asp
x
 Tintinalli, Judith E., Gabor D. Kelen, and J. Stephan.
Stapczynski. Emergency Medicine: A Comprehensive
Study Guide. New York: McGraw-Hill, Medical Pub.
Division, 2004.
 Wheeles, Clifford. "Wheelesonline.com."
Wheelesonline.com. Duke Orthopedics. Web. 04 June
2012. <http://www.wheelesonline.com/ortho>.