Otto E. Aufranc

Trimalleolar Fracture of Ankle

Dr. E. T. Wyman, Jr.: A 46-year-old housewife fell 5 feet from a ladder, catching her left ankle in the ladder as she fell. Because of continuing pain and inability to walk, the patient was brought to the emergency ward of the Massachusetts General Hospital 11 hours later. A work-up revealed her to be an extremely dependent and worried woman who was in good general health. Her injuries were limited to her left ankle which was severely swollen; lateral displacement of the foot was apparent. The skin was in good condition except for edema, and there was no motor, sensory, or circulatory deficit in the foot. Dr. O. E. Aufranc: I would like to ask Dr. William Kermond to discuss the management of this fracture. Discussion of Management Dr. W. L. Kermond: A review of the roentgenogram, in conjunction with the patients history, indicates this fracture resulted from a forced

Trimalleolar Fracture Dislocation

Dr. E. T. Wyman Jr.: A 63-year-old housewife fell in a store approximately 15 minutes before admission to the emergency ward of the Massachusetts General Hospital. Examination of the left ankle revealed an external rotation, abduction deformity, and moderate swelling. Pain was considerable and tenderness was generalized. The skin was in good condition. Circulation was good in the foot, and impairment of motor or sensory nerve function was not found. The patients health was good except for moderate hypertension in the range of 190/110 mm. Hg, which had been treated for a year by hypotensive agents. She had no known cardiac complication. Thirteen years before admission she had had an episode of upper gastrointestinal bleeding diagnosed as a peptic ulcer, which had responded well to medical therapy. X-ray films of the ankle revealed a trimalleolar fracture dislocation (Fig. 1). Discussion of Treatment Dr. O. E. Aufranc: This fracture dislocation of

Fracture of the tibia and fibula. Presentation of case.

ABSTRACT Dr. J. H. Dimon: A 51-year-old maintenance man was admitted to the emergency ward of the Massachusetts General Hospital in November, 1958, one hour after being struck by an automobile. He was conscious and not in shock. The right leg, which had been wrapped in a pillow splint, revealed an open transverse fracture of the midshaft of the right tibia and fibula (fig. 1 and 2). The bone was exposed from the anterior tibial tubercle to 2 cm. above the ankle joint, and the skin was sleeved circumferentially over this area. Sensation and circulation were present in the foot, and the dorsalis pedis pulse was palpable; the posterior tibial pulse was absent. The wound was grossly contaminated with clothing and dirt, and there was little bleeding from the area. No other significant injuries were present. The patient had always been in excellent health prior to the accident. He had had