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that’s gotta hurt

Here’s one of those posts that medical and non-medical readers might find interesting out of the same morbid curiosity to see some extreme (-ly painful) medicine. 

This wasn’t a patient of mine but rather one of those times where you see another group of doctors around a computer looking at an x-ray and collectively hear them say “DAAAAAAAMMMMMMMNNNNNNNN” so out of morbid curiosity you have to go over and see what the fuss is all about.   

Everyone together now--DAAAAAMMMMMMMNNNNNNN

Everyone together now--DAAAAAMMMMMMMNNNNNNN

I present to you a patient who fell poorly on the right ankle and destroyed it.  At least that’s the story.  You question my skepticism?  Look at that film–that’s pretty bad for a fall. 

Anyway, you see all of those red arrows I added to show all of the different places where this patient’s ankle was broken?  That’s not normal.  That’s not even the typical ankle fracture.  And I caught a glimpse of the patient.  This patient was in a world of hurt.  A world of hurt. 

So this would be a comminuted tibia/fibula (tib/fib) fracture.  It’s not an “open” fracture since the bone wasn’t sticking out of the skin but it was close.  Like bone right under the skin close.  But, I’m not an orthopedic surgeon so I won’t even pretend to know much about different fracture types, etc. so I will refer you to wikipedia…  In any case, this patient’s ankle is a bag of bones at the moment and will be going to the OR in the very near future.  And, will likely have a very difficult recovery ahead. 

One thing I will say about medicine is that just when you think your day was about as bad as it could possibly get, you see something like this and you realize things can always be worse.  Like having to manage 25 really sick patients, do 3 admissions and discharge 8 patients on a shattered ankle.  Although, on a more serious note, I will say in hindsight that there were days in graduate school where if you had taken an x-ray of my dreams/hopes/desires/career prospects, it would have looked something like this.  Who knows what I’m talking about?  That’s right, everyone with a PhD should be raising their hand.


5 Responses to “that’s gotta hurt”

  1. 1

    after 3 weeks of anatomy/med school i’ve been struggling through the radiology lectures like it’s my job (i guess it is my job) and i come to the internets for fun reading to find this entry. i’m going to go sit in a corner and rock myself now.

  2. 2

    DAAAAA-AAMN. What did he do, have a “bad fall” off a roof? I wonder what forces could have taken a curved chunk out of the side like that.

    That’s what you call a student-grade lesion.

  3. 3

    Yeah–when a medical student or dumb-ass intern can look at an x-ray and identify the problem, that’s not a good thing for the patient.

  4. 4

    This is a tibial plafond/pilon fracture. It’s not your standard ankle fracture which usually occurs due to a twist; instead this is an axial injury. Horsetech: the lowest energy injury I’ve seen create this fracture pattern is a lady falling backward off a kerb in stillettos (ie impact from about 1 foot). It’s usually a high energy injury although landing badly when jumping off a low platform can cause it.

    These are notoriously difficult to treat and have poor outcomes.

  5. 5

    What’d he do? Jump 20m out of helocopter above a parking lot?

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