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Case Report: U. Tarantino, G. Cannata, E. Gasbarra, L. Bondi, M. Celi, and R. Iundusi Open medial dislocation of the ankle without fracture J Bone Joint Surg Br 2008; 90-B: 1382-1384 [Abstract] [Full text] [PDF]

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Umberto Tarantino, Giuseppe Cannata, Elena Gasbarra, Lucia Bondi, Monica Celi, and Riccardo Iundusi   (23 October 2008)

Open medial dislocation of the ankle without fracture

Chris Peach   (17 October 2008)

Authors' reply: 23 October 2008
Umberto Tarantino, Chief of Orthopaedic and Traumatology Department University of Rome, Giuseppe Cannata, Elena Gasbarra, Lucia Bondi, Monica Celi, and Riccardo Iundusi Send letter to journal: Re: Authors' reply: umberto.tarantino{at}uniroma2.it Umberto Tarantino, et al.	Sir, We thank Mr Peach for his comment about our case report. We would like to explain two different aspects about this case. First of all, when a trauma patient is admitted to our accident and emergency department he is usually visited by the emergency doctor. In this specific case the doctor decided to take an x-ray first (which only takes a few seconds thanks to the efficient organisation of our department) to exclude other pathologies such as related fractures. Secondly, as regards the clinical picture, because we are a university hospital a resident took the picture for the orthopaedic consultant as he was preparing for the reduction. The whole process took no more than ten minutes. We believe that this timing is reasonable and we are encouraged by the excellent clinical result obtained. U. Tarantino, Chief of Orthopaedic and Traumatology Department, G. Cannata, E. Gasbarra, L. Bondi, M. Celi, R. Iundusi, University of Rome, Rome, Italy.
Open medial dislocation of the ankle without fracture 17 October 2008
Chris Peach, Orthopaedic Specialist Registrar East Lancashire Hospitals NHS Trust Send letter to journal: Re: Open medial dislocation of the ankle without fracture c.peach{at}doctors.org.uk Chris Peach	Sir, I would like to thank the authors of this case report for highlighting an interesting case and the fact that patients can achieve a good outcome after a horrendous injury. What I was disappointed to see in the documentation of the injury was the colour plate and the x-ray of the dislocated ankle. As the authors themselves commented in their concluding remarks, immediate reduction in the emergency department is crucial in preventing soft tissue, vascular and neurological complications.1 This should be performed without delay. I am concerned that these pictures might have significantly delayed this important initial treatment. The outcome eventually was good, however, I believe that all orthopaedic trainees should remember that an x-ray of a dislocated ankle is an x-ray that should not have been taken at all. C. Peach, Orthopaedic Specialist Registrar, East Lancashire Hospitals NHS Trust, Lancashire, UK. 1. Denham RA. Internal fixation for unstable ankle fractures. J Bone Joint Surg [Br] 1964;46-B:206-211.