Welcome to the Emergency Medicine Cases Podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

I can't remember the last time I worked a shift in the ED and didn't see at least one patient with an ankle injury.

Of course, all of these patients are relatively straightforward to diagnose and manage because the vast majority will end up being simple ankle sprains or obvious fractures.

But there's a good three or four or five percent of patients who will have a more

elusive diagnosis that if not identified early could lead to significant morbidity. On the flip

side, if we're super conservative and defensive and we immobilize everyone with an ankle injury,

no matter how minor, we're not going to do our patients or our consultants

any favors. Just as we shouldn't accept a three or four or five or six percent misrate for

ACS or PE or Cata Aquinas syndrome, we shouldn't accept this high a misrate for serious ankle

injuries either. We can do better. So with this goal in mind,

and with the help of Canada's leading ED ortho educator, Aaron Ciel, the brains behind the

casted course, the auto ankle don't ask us to examine the anterior joint line of the ankle.

And Hussain Median, our Jedi master orthopedic surgeon, North York General.

Basically, examination of the deltoid ligament under ultrasound

is probably not very accurate, and it will not add to your knowledge.

We're going to cover a general way of thinking about ankle injuries,

the limitations of the Ottawa ankle rules, a simplified approach to the ankle x-ray, and the importance of identifying the external rotation mechanism of injury.

We're going to cover a few important, commonly missed serious ankle injuries like lateral maliolis fractures with a deltoid

ligament injury. Sinismosis injuries and telo fractures. The more subtle mesonov fractures.

And lastly, the sometimes elusive talus fractures like the snowboarders fracture and

Taylor Dome fractures. So without further ado, here's commonly missed ankle injuries on EM cases.

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