Clinical Challenge: November, 2015

The Resolution

Diagnosis
Bimalleolar ankle fracture with dislocation (Figure 2).

Learnings
Suspect a bimalleolar fracture on the basis of the mechanism of injury, visible deformity, and significant pain. Distinguish between isolated bimalleolar fracture and bimalleolar fracture–dislocation. Check the proximal and distal joint to ensure that there is no Maisonneuve fracture (spiral fracture of the proximal fibula). A bimalleolar fracture is an unstable fracture that requires splinting, avoidance of weight-bearing, and usually surgery. If the patient will be sent home, ensure that the mortise is intact and that there is no dislocation, and arrange with an orthopedist for rapid orthopedic follow-up.