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Dr. E. T. Wyman Jr.: A 63-year-old housewife fell in a store approximately 15 minutes before admission to the emergency ward of the Massachusetts General Hospital. Examination of the left ankle revealed an external rotation, abduction deformity, and moderate swelling. Pain was considerable and tenderness was generalized. The skin was in good condition. Circulation was good in the foot, and impairment of motor or sensory nerve function was not found. The patient's health was good except for moderate hypertension in the range of 190/110 mm. Hg, which had been treated for a year by hypotensive agents. She had no known cardiac complication. Thirteen years before admission she had had an episode of upper gastrointestinal bleeding diagnosed as a peptic ulcer, which had responded well to medical therapy. X-ray films of the ankle revealed a trimalleolar fracture dislocation (Fig. 1).
Discussion of Treatment
Dr. O. E. Aufranc: This fracture dislocation of
Aufranc OE. Trimalleolar Fracture Dislocation. JAMA. 1960;174(18):2221–2223. doi:10.1001/jama.1960.63030180004010
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