Rearfoot / Ankle · Trauma · Medicine & Peri-op · Standard
Hole in the Ground
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 and my ankle is badly hurt."
72-year-old female brought to the ED by EMS after stepping into a hole.
History of present illness
Mechanical fall while walking when her right foot went into an eroded hole in the ground, twisting the ankle. EMS placed a splint and gave cefazolin en route.
- Denies syncope, head strike or other injuries
- Active at baseline, ambulates without an assistive device
- Immediate deformity and pain; an open wound over the medial ankle
- Tetanus: up to date per ED chart
- NPO: last oral intake several hours before the fall
Questions a strong candidate asks at this step
- Mechanism: mechanical vs. syncopal fall; foot position at impact (twist, inversion/eversion); height and energy
- Syncope, head strike, LOC, other injuries (primary and secondary survey)
- Open wound? Time of injury, ground contamination (soil/hole), antibiotics given and when
- Splinting, reduction attempts, neurovascular status before and after
- NPO status, last oral intake, tetanus status
- Baseline function and ambulation; prior ankle injury
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.