Question

An RTA patient presented to the emergency department with severe pain in the Ankle, an X ray was performed, given below. What is the best next step of management?

• A. Neurovascular Assessment and Closed reduction and slab application
• B. Neurovascular Assessment and Closed reduction and cast application
• C. Neurovascular Assessments and Immediate surgery
• D. Neurovascular Assessments and Immediate open reduction

Answer 1

The Correct Option is A

In managing an ankle injury following a Road Traffic Accident (RTA), the primary concern is to assess and stabilize the injury correctly. Here is a detailed approach to solve the problem presented:

1. Initially, perform a Neurovascular Assessment. This step is crucial to ensure there is no compromise to blood supply or nerve function distal to the injury.
2. Based on the assessment, decide on the appropriate management to stabilize the injury. The options include:

• Closed Reduction: This is a non-surgical procedure to realign the bones.
• Slab Application: A slab is a semi-rigid form of immobilization that allows for swelling.
• Cast Application: It provides full immobilization but is not suitable immediately due to potential swelling.

3. Considering the severity of pain and the typical emergency protocol for fresh fractures:

The best next step is to Neurovascular Assessment and Closed reduction and slab application. This allows reduction of the fracture while accommodating for post-traumatic swelling, thereby preventing complications such as compartment syndrome.