Pediatric emergency medicine trisk 0808 0808
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TABLE 40.4
CLASSIFICATION OF ANKLE SPRAINS
Grade I: Mild
sprain
Grade II:
Moderate sprain
Grade III: Severe
sprain
Ligament injury
Swelling
Tenderness
Functional loss
Minor
Mild
Mild, local
Minimal
Joint stability
Stable
Near complete tear
Moderate
Moderate, diffuse
Ambulates with
difficulty
No/mild instability
Complete rupture
Severe
Marked
Inability to bear
weight
Unstable
EVALUATION AND DECISION
History
Trying to obtain a reliable history in ankle injuries can be difficult. Commonly,
the description is: “I twisted it and it hurts.” Nevertheless, the mechanism of
injury, if obtainable, can provide a clue to the diagnosis. Other questions include
the following: (i) When did the injury occur? (ii) Did swelling occur immediately
or gradually? (iii) Is there a history of any previous injury to that limb? and (iv)
Does the patient have a history of any other medical problems—osseous,
neurologic, or muscular disease?
A history of fever, rash, or other joint involvement, in combination with a
history of minimal or no trauma, suggests nontraumatic diagnoses such as septic
joint, arthritis, or collagen vascular disease.
Physical Examination
General Inspection
Look for obvious deformities, open wounds, loss of anatomic landmarks, local
swelling, and ecchymosis. If an obvious deformity is present, keep manipulation
of the extremity to a minimum and assess neurovascular status promptly. Any
break in the skin may communicate with the joint space or constitute an open
fracture. The need for antibiotic coverage should be evaluated immediately.
Neurovascular Evaluation
