Rearfoot / Ankle · Trauma · Infection & Wound · Advanced
ED Consult
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
"My ankle is out of place and the bone is sticking out."
35-year-old male brought in by EMS after a motor vehicle accident; the podiatry service is called to the ED in the early morning to help reduce a dislocated ankle and decide whether surgery is needed.
History of present illness
Restrained driver in a high-energy MVA with the right foot forced under the pedals/dashboard; the ankle was twisted violently and the foot was obviously deformed at the scene.
- Immediate severe ankle pain, unable to bear weight
- Open wound over the medial ankle with bone and tendon visible; bleeding controlled with a pressure dressing by EMS
- Foot felt cold and numb for a short time at the scene, then partially returned
- Ate several hours before the accident; last oral intake > 6 h ago
- Tetanus status unknown; no antibiotics yet
- No loss of consciousness; denies chest or abdominal pain; no other limb complaints
- Time of injury roughly 1-2 hours before the call
Questions a strong candidate asks at this step
- Mechanism, speed, restraint, ejection, entrapment, time since injury
- Open wound? Time to antibiotics and tetanus status
- Neurovascular symptoms: coldness, numbness, color change
- Other injuries (head, chest, abdomen, spine, other extremities) and ATLS status
- NPO status (last meal), last drink
- Pain control given so far; prehospital splinting
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.