46 year old female with a history of lupus and chronic stero | Figure 1
Candlemaker
Case Study
Patient Details: 46-year-old female with a history of lupus and chronic steroid use. Sustains a fall injuring her left ankle.
Initial Assessment: She was seen at an outside hospital where she stated her ankle was reduced. On exam, she has robust diffuse swelling. Radiographs and CT images note the trimalleolar fracture with talar translation. She is splinted with strict elevation instructions pending surgery.
Questions: How would you fix this injury? What approach(es) would you use? What would be your order of fixation?
Recent Cases
Case 1: 22-year-old male jumped from a one-story roof for fun while intoxicated. Splinted in our ER awaiting transfer to a facility with orthopedics. What type of splint would you use?
Case 2: A 36-year-old female underwent an open reduction internal fixation of her R tibia using an IMN exactly 6 weeks ago. She complains of pain around her ankles and lateral aspect of her knee. Surgeon instructions were strengthening and gait training (WBAT) using a walker up to 5 weeks and now she is ambulating using a cane. Any thoughts?
Case 3: A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An ECG was performed in the primary care setting, and the patient was promptly referred to the emergency department.
Case 4: A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
Case 5: A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
Case 6: Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?