Derek Burke left the Childrens about 18 months ago in Sheffield. Went to
Birmingham. Resigned almost immediately. He is now back in the Childrens
in Sheffield.
Andy Webster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
ACCIDENT & EMERGENCY - SwarkHosp-TR
Sent: 24 February 2003 09:07
To: Andrew Webster
Subject: Re: Ankle injuries
Nothing much published on the natural history of ankle sprains (bit of
stuff
in the sports medicine journals but most of it looks at range of motion
rather than swelling and of course it is a very selected population).
Derek
Burke did some work when he was a registrar, but didn't publish (he's
working in Paeds EM at the moment, I think still in Sheffield, although
I
know he was thinking of moving to Birmingham Childrens so may be there
now).
May be worth getting in touch with him.
My experience of late presentations of sprained ankles (and indeed early
presentations that don't improve significantly over the first 48- 72
hours,
which is probably the same thing) is that a lot of them have partial
ruptures (and less commonly, subluxation) of the peroneus tendons- while
the
maximal tenderness is obviously over the tendon itself, there certainly
is
swelling and tenderness over the posterior border of the lateral
malleolus.
Unfortunately I've yet to persuade our radiologists that patients with
acute
ankle injuries warrant an ultrasound.
Anyway, my money is on the reason for more late presenters fitting the
Ottawa criteria is that persistent pain beyond 48 hours is more likely
to be
due to a different injury (but one not associated with a fracture).
Despite
the fact that you have a lower positive x-ray rate you're actually
dealing
with a more serious injury (persistent pain an loss of function for
several
weeks is common). This is one problem with x-rays- they emphasise the
importance of bone rather than soft tissue injury.
Matt Dunn
Warwick
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