Ankle Pain Secondary To A Wakeboarding Accident: 3237 May 30, 9

HISTORY: JA is a 17 year old female with a chief complaint of a right ankle injury she sustained after suffering an injury while wakeboarding. She was strapped into her board bindings with her right foot in front closest to the boat. She was originally riding within the boat wake, but then began to ride over the wake and lost her balance. Her foot remained planted in the bindings, but her body veered off to the right as she fell into the water. JA had immediate pain and swelling in her right ankle. She was unable to weight bear on the right leg and was immediately brought to an urgent care facility for evaluation. PHYSICAL EXAMINATION: Examination of the Right ankle: Inspection: Mild swelling diffusely over the right ankle, no gross deformity noted; no ecchymosis. Palpation: Tenderness to palpation over the lateral talus just anterior and inferior to the lateral malleolus; Also tender to palpation over the ATFL. No lateral or medial malleoli tenderness. No tenderness over the base of the 1st or 5th metatarsals. Special test: squeeze test for high ankle sprain negative DIFFERENTIAL DIAGNOSIS: ankle sprain/ligamentous injury fracture Navicular fracture vs, dislocation peroneal dislocation vs tear disruption of the ankle mortise bone contusion TEST AND RESULTS: X-rays of the right ankle from the outside urgent care facility were reported as normal. On our review of the imaging, we were concerned about a lateral talus fracture. Repeat imaging was done in clinic on the day of presentation and did show a non-displaced fracture involving the inferior lateral talus. Due to the nature of her injury a CT scan of the right ankle without contrast was ordered. CT results returned as a mildly comminuted fracture through the lateral talar process with fracture lines extending into the anterolateral aspect of the posterior subtalar joint. Minimal displacement of the comminuted fracture fragments anteriorly and inferiorly. FINAL WORKING DIAGNOSIS: Right comminuted fracture through the lateral talar process TREATMENT AND OUTCOMES: The case was discussed with our orthopedic trauma surgeon. The various options of surgery versus non surgical management was discussed. The decision was made to proceed with operative treatment (primary excision).