Pediatric emergency medicine trisk 0815 0815
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surface and are therefore less stable. They require anatomic realignment,
frequently by open reduction. A long leg cast is commonly applied in any
rotational injury.
Sprains
A common approach to the treatment of ankle sprains is described by the “RICE”
(rest, ice, compression, elevation) mnemonic. It should be initiated within 36
hours of the injury.
Rest —The patient is allowed to ambulate/exercise only if the activity does not
cause pain or swelling during or within 24 hours. Otherwise, crutches and light
weight bearing are recommended until ambulation without pain is possible.
Ice —Apply ice directly to the ankle for 20 minutes, every 2 hours if possible,
for the first 48 hours post injury.
Compression —The purpose of compression is to keep (and/or push) fluid out
of the area of the ankle joint. This can be accomplished using an elastic bandage
starting at the foot and wrapping proximally toward the ankle. For additional
compression, any bulky padding can be applied to the malleoli and then secured
with an elastic wrap. The combined application of an elastic wrap covered with
an air-stirrup ankle brace may allow for an earlier return to normal function than
either device used alone.
Elevation —To help decrease or prevent swelling, elevate the ankle as often as
possible.
Splinting
If swelling or pain is severe, apply a stirrup and/or posterior splint to the ankle
(see Chapter 130 Procedures , Splinting of Musculoskeletal Injuries). Air splints
can also be used; they allow dorsiflexion and plantar flexion while maintaining
medial and lateral stability.
Rehabilitation
Plantar flexion and dorsiflexion exercises initiated as soon as possible, followed
by toe raises and inversion/eversion exercises may shorten the period of disability
considerably.
Orthopedic Referral
Absolute indications for orthopedic referral include (i) obvious deformity with
growth plate involvement, (ii) S-H type III, IV, and V physeal fractures, (iii)
neurovascular compromise, (iv) open fracture, (v) suspected syndesmotic injury
or high ankle sprain, (vi) a grade III sprain, and (vii) locking of the ankle.
