Author Question: Ankle Injury

Elaine Asks:

I have a medical question on my WIP that I was wondering if you can help me with. I have a 72-year-old woman who falls and hurts her ankle. It swells and throbs and her family brings her to the ER. From my research I gather that she can have a sprain as opposed to a break. I need her to be somewhat mobile because she needs to rush to a caving site where her son is trapped. Is it feasible to think that she can use crutches, can drive, pushing aside that she’ll pay a price afterwards? Any suggestions?

Jordyn Says:

Ankles are 95% of the time sprained and not broken. So yes, this is feasible. If you want her driving– I’d probably injure the left foot so there wouldn’t be major difficulties with driving. Crutches/air splint/or ace wrap for 7-10 days and then re-evaluate after that if her pain is not improved.
Here’s a link that pertains to your question:
Elaine Stock is a former RWA member and has presented several writing workshops. Presently involved in ACFW, she was a 2011 semi-finalist in the prestigious Genesis Contest in the contemporary fiction division. She is also active on several social networking groups. Her first short story was published on Christian Fiction Online Magazine. New to the blogging world, Elaine started a blog this past April, Everyone’s Story. Since then, the blog has been graced by an awesome international viewership that totally pings her heart. Everyone’s Story features weekly interviews and reflections from published authors, unpublished writers…and just about anyone who wants to share a motivating story with others that may lift their spirit. She has also been the guest of several other blogs, helping to further grow her presence on-line.

She and her husband make their home in an 1851 Rutland Railroad Station they painfully but lovingly restored.

Author Question: Treatment of Minor Injuries

Maisie Asks:

I’m writing today with a medical question, I really appreciated the flow of your medical expertise in Proof, with it being a part of the story, and not a distraction from the story. I want to accomplish that same steady flow with my current work in progress.

My 16-year-old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I’ve never broken anything to know how it feels.

I want the medical scene that follows to be realistic. Her Mom will meet her at the hospital, it’s late at night. What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don’t want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they’ll look for, and how this is going to encumber her in her regular life.

Jordyn Says:

Thanks so much for sending me your question.
The thing to know about ankles is that they rarely fracture– 95% of the time they are sprained. For a sprained ankle, an air splint (crutches if the patient can’t bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful– they should follow-up with their regular doctor or orthopedic doctor at that time.
It’s more likely, with your scenario of falling down a hill, for a simple break to the lower forearm. Treatment in the ER would be x-ray to evaluate for fracture, and pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast. Patient will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn’t be any permanent damage.
Lacerations: generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn’t had one in the last five years.

Welcome Dr. Frank Edwards!

I’m so pleased to announce a new monthly guest blogger to Redwood’s Medical Edge. Dr. Edwards is an emergency medicine physician and will be adding a wealth of information concerning adult ED medicine. I hope you’ll take the time to check out his medical thriller, Final Mercy. Welcome, Dr. Edwards!
Cracking Joints
Frank J. Edwards, MD
You’re coming down a set of steps and become distracted, or you’re jogging and don’t see the pothole, or you’re playing soccer, or maybe you’re strolling in the park at dusk, when suddenly an ankle you’ve always taken for granted painfully twists inward and you hear a snap.  Next morning, the outward (lateral) side of your ankle is swollen and bruised, and weight bearing is not a happy experience.  Surely, it is broken.  You even felt the crack.

Ankle injuries are among the most common presenting complaints to emergency departments and urgent care centers.   The ankle is a very flexible hinge-type joint, held together by ligaments and mainly designed to flex upwards and push downwards when we ambulate.  It also allows for inward and outward movements (inversion and eversion) and even some degree of rotation side to side.  Every joint has inherent weaknesses, and the ankle’s Achilles’ heel (so to speak) is excessive inversion.  In other words, it does not take much force to twist the ankle inwards beyond its structural limitations.  Reach down and check it out.   When this happens, the ligaments on the outside (lateral aspect) of the ankle will stretch and tear, or sometimes even rip off a sliver of bone.   By definition, this is a sprain.  However, given enough force, the same mechanism of injury can cause true fractures, sometimes even severe enough to require surgery.

The vast majority of ankle injuries, however, do not involve broken bones and are completely healed within a week.  The question is—when do you need an x-ray?  Fortunately, we have some good research to guide us, something called the Ottawa Ankle Rules (thank the cost-conscious Canadians for this one), which that allows us to predict the likelihood of fracture. 
Basically, the Ottawa Ankle Rules say that: 1) if the patient was able to bear weight right after the injury; 2) if there is no tenderness to pressure over the tip of the fibula (the bone running down the outside of the lower leg); 3) if there is no tenderness over the base of the fifth metatarsal (the outermost of the five long bones in the foot), and; 4) if the ankle is otherwise stable—the chance of a significant fracture is slight. 
When a patient meets these criteria, we can skip the x-ray for now.  Give the injured person a splint and crutches, and save tens of millions of health care dollars a year.  Many health care providers, however, are either unfamiliar with the rules or unwilling to disappoint a patient’s expectations that the visit is incomplete without some radiation.   Especially if the patient “heard it snap.”   However, in my years of ED experience, this sensation usually points toward a sprain.  It is like cracking your knuckles.

Frank Edwards was born and raised in Western New York.  After serving as an Army helicopter pilot in Vietnam, he studied English and Chemistry at UNC Chapel Hill, then received an M.D. from the University of Rochester.  Along the way he earned an MFA in Writing at Warren Wilson College.  He continues to write, teach and practice emergency medicine. More information can be found at