This last week was interesting in that I relocated two completely dislocated ankles. Two in one week seemed surprising since I relocate an ankle at Northwest about every year or so. The first young man had been in a car accident around three in the morning and friends took him to a nearby hospital. He brought an x-ray that showed a completely laterally dislocated left ankle. The hospital had also fashioned a posterior plaster ankle splint that did a fine job of keeping his leg firmly dislocated. We wouldn’t want the ankle flopping around. He shows up outside the ER around noon in a friend’s car with a referral note from the other hospital. The distal tibia is completely exposed as the skin over the medial malleolus has torn open. I track down a vial of 500mic fentanyl and after 350mics he tolerates me pulling his ankle back into place. He can even wiggle his toes afterwards, and has a good DP pulse. He then went off to the OR for a thorough washout and an ex-fix.
A day or two later another young man shows up straight from a walking injury to his right ankle. He has fallen and suffered a complete medial dislocation with the distal tib/fib exposed and a large skin tear over his lateral malleolus. I find more fentanyl and after giving him 650mics he is still talking on his cell phone but he doesn’t seem to mind when I pull the ankle back into place.
People here are very pain tolerant. They don’t do a lot of screaming/writhing around like I would if I had the same ailment.
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