Rearfoot / Ankle · Trauma · Standard
Fall Onto Ankle
Podiatric surgery residency interview case. Work through it the way you would at an interview: take the history, ask for the exam and imaging, then commit to a diagnosis and plan.
Chief complaint
"I fell on my ankle and the doctors in the ER said I need surgery."
53-year-old female seen in the podiatric surgery clinic 3 days after the injury, currently non-weight-bearing in a splint.
History of present illness
Fell onto her left ankle 3 days ago. Seen in the ER the same day, where radiographs showed a left ankle fracture; she was splinted, told to be non-weight-bearing and told she would need surgery. Pain is "not bad but noticeable" in the splint.
- Mechanism: fall with a supination/external-rotation-type twisting load to the ankle
- Weight-bearing since: none, NWB in splint with crutches
- No numbness, no open wound, no other injuries
- Last oral intake and tetanus status are checked at the pre-operative visit
- Non-diabetic
Questions a strong candidate asks at this step
- Mechanism: height of fall, foot position, twisting vs axial load, high vs low energy
- Onset and time since injury; able to bear weight afterward?
- Pain level and character; numbness, tingling, color change in the toes
- Open wound or bleeding at the time of injury (open vs closed fracture)
- Treatment so far: ER films, reduction, splint, ice/elevation, analgesics
- Syncope or dizziness causing the fall (medical vs mechanical fall)
Present the rest of the case
Past history, exam, imaging, assessment, plan and discussion questions, with model answers, are in the interactive trainer. The diagnosis is kept there on purpose so you can practice committing to one.