Ankle Injuries In The ED: How To Provide Rapid And Cost-Effective Assessment And Treatment

5:23 p.m.: A 5-year-old boy presents with a swollen ankle after jumping off of the monkey bars at school. The ankle is only slightly swollen and tender, and the films are normal. This ankle sprain gets an Ace wrap and goes home. You think, “I wish all my cases were this simple.” 6:18 p.m.: A 50-year-old “weekend warrior” everted his right ankle sliding into home. While the ankle is swollen, the x-ray only shows an avulsion of the medial malleolus. Another “slam dunk”—you discharge the patient home with a posterior splint and a diagnosis of chip fracture. These two cases seen within the hour have one thing in common: In each, the diagnosis and treatment are wrong.