Primary Diagnosis
Fracture of the medial malleolus (S82.5): is a common lower limb injury that occurs when a foot is forcefully rolled inwards or outwards (Crosswell, Rhee, & Wagner, 2014, p. 1). The main signs of medial malleolus fractures are pain in the inner side of the ankle, difficulties in walking, and cases of swelling and bruising of the ankle. In this case, the patient says that she could not bear weight and was unable to walk independently. Elizabeth, as well as others present in the room during the accident, heard a “popping” sound that could be identified that the ankle was chipped off. Besides, she had a groin pull several months ago. At the moment, Elizabeth’s ankle is mildly edematous with ecchymosis and tender to palpation. She could not move her leg, and even passive ROM is painful to her. The office X-ray shows acute avulsion of the medial malleolus.
Treatment Plan
Diagnostics
Computer tomography (CT) should be offered as a possibility to define the type of fracture, the displacement of the injury, and the type of treatment plan that could be offered to the patient (Eismann et al., 2015, p. 999). It helps to reveal more important details about the structure of the bone and the nature of tissue that could surround it.
Magnetic resonance imaging (MRI) that is organized on the basis of radio waves helps to create a detailed image of the ligaments of the patient and provides the doctor with an opportunity to choose an appropriate treatment plan (Ha et al., 2015).
Medication
Rx: Acetaminophen 4 g. Sig: daily in 4 doses. Disp: #14. Refill: #2 (Luiten et al., 2014, p. 2). This medication should help to decrease the level of pain connected with the fracture of the ankle.
Rx: Diclofenac 50 mg. Sig: three times per day. Disp.: 30. Refill: #1 (Luiten et al., 2014, p. 2). This drug could be used to reduce the possibility of the inflammation process.
Conservative Measures
The mother or other relatives, who could take care of the patient, should provide Elizabeth with help and support to avoid stresses or extra loads on the leg. It is also important to promote immobilization of joints for a certain period of time before the next visit to a doctor (Malinin & Temple, 2016, p. 195).
Education
It is important to instruct the patient about the necessity to control any pain and not to jump to a conclusion after each pill is taken. Elastic bandages could help only in case they are removed every 2-3 hours for 15 minutes (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013, p. 983). Home and yard checks should also be frequent and organized by a person, who could notice the shortages and make the corrections/improvements in a short period of time.
Referrals
An orthopedist must be consulted (Buttaro et al., 2013, p. 982). This doctor should help to analyze the results of X-rays and CT and provide the patient with instructions to be used in the management and hospitalization in cases of emergency. Physical therapy is another issue for consideration. A therapist could help the patient to learn how to use assistive devices, and a psychologist could explain the worth of treatment and the necessity to make and accept changes.
Follow-Ups
The next six months should be the period to follow up (Beckenkamp et al., 2014, p. 841). Still, the conditions could be changed in the doctor wants to observe the changes or the patient feels discomfort.
References
Beckenkamp, P. R., Lin, C. W. C., Chagpar, S., Herbert, R. D., van der Ploeg, H. P., & Moseley, A. M. (2014). Prognosis of physical function following ankle fracture: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy, 44(11), 841-851.
Buttaro, T.M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary Care: A Collaborative Practice. (4th ed.). St. Louis, MO: Elsevier Mosby.
Crosswell, S., Rhee, S.J., & Wagner, W.W. (2014). Unusual fracture combination in a paediatric acute ankle (combined medial talar compression fracture with medial malleolus fracture in an immature skeleton): A case report. Journal of Surgical Reports, 10, 1-4.
Eismann, E. A., Stephan, Z. A., Mehlman, C. T., Denning, J., Mehlman, T., Parikh, S. N.,… & Zbojniewicz, A. (2015). Pediatric triplane ankle fractures: Impact of radiographs and computed tomography on fracture classification and treatment planning. The Journal of Bone & Joint Surgery, 97(12), 995-1002.
Ha, S., Hong, S.H., Paeng, J.C., Lee, D.Y., Cheon, G.J., Arya, A., Chung, J.K., Lee, D.S., & Kang, K.W. (2015). Comparison of SPECT/CT and MRI in diagnosis symptomatic lesions in ankle and foot pain patients: Diagnostic performance and relation to lesion type. PLoS One, 10(2). Web.
Luiten, W.E., Schepers, T., Luitse, J.S., Goslings, J.C., Hermanides, J., Stevens, M.F., Hollmann, M.W., & Samkar, G. (2014). Comparison of continuous nerve block versus patient-controlled analgesia for postoperative pain and outcome after talar and calcaneal fractures. Foot & Ankle International, 2014. Web.
Malinin, T.I. & Temple, H.T. (2016). Fracture healing: An overview of existing concepts. Current Orthopaedic Practice, 27(2). 192-197.