A 46-Year-Old Man Comes to the Emergency Department for Evaluation

question 5

Multiple Choice

A 46-year-old man comes to the emergency department for evaluation of left ankle pain.  The patient was walking down a flight of stairs when he missed a step and landed on the lateral aspect of his foot.  He immediately experienced pain in the ankle that has progressively worsened over the past 4 hours despite ibuprofen and application of ice.  The patient's medical conditions include chronic hypertension and hyperlipidemia.  Temperature is 36.7 C (98 F) , blood pressure is 130/80 mm Hg, and pulse is 76/min.  BMI is 29 kg/m².  Examination of the left ankle shows significant bruising over the lateral aspect.  Range of motion is limited on external rotation of the foot due to pain.  There is no tenderness to palpation over bony prominences of the ankle and sensation is normal.  The patient can walk to the examination room but has a significant limp.  Which of the following is the best next step in management of this patient?

• A)Ankle brace
• B)Immediate surgical fixation
• C)Intraarticular corticosteroid injection
• D)MRI of the ankle
• E)X-ray of the ankle

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An approach to justice that focuses on repairing the harm caused by criminal behavior through cooperative processes involving all stakeholders.