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March 28, 1959


Author Affiliations


Assistant Clinical Professor of Surgery, Harvard Medical School; Surgeon, Peter Bent Brigham Hospital; Surgeon, Harvard University Health Services.

JAMA. 1959;169(13):1431-1436. doi:10.1001/jama.1959.03000300027006

Inexact diagnosis and inappropriate treatment of ankle injuries can lead to serious disability. Decisions regarding them should be left to a physician whose authority should not be questioned. The patterns of fracture of the malleoli as seen in anteroposterior roentgenograms can give valuable information about concomitant rupture or avulsion of ligaments. If advantage is taken of the 20 to 30 minutes after injury before edema, hemorrhage, and spasm occur, closed reduction of even grossly displaced fractures can sometimes be accomplished with almost no discomfort. If roentgenograms indicate that soft tissues are ruptured or trapped between bony parts, prompt surgical correction is indicated. Cold, compression, rest, and elevation are the four basic elements of treatment for minor injuries. There is no justification for the use of procaine as an immediate therapeutic agent in any athletic injury. Operation was necessary in the case here described, but active motion without weight-bearing was started at 3 weeks, weight-bearing was permitted at 15 weeks, and skiing was resumed at 18 weeks after the injury.