Author: Kashif Ijaz Malik / Editor: Nick Tilbury / Codes: SLO4, TC4, TP7 / Published: 12/05/2023

A 15-year-old boy attends the paediatric emergency department (ED) with left ankle pain.

He was skateboarding with his friends when he suddenly lost balance and twisted his left ankle. His friends managed to get him on his feet but he has found it difficult to weight-bear on the left leg since the fall. He managed to hobble to the car that brought him to the emergency department and has been able to walk with pain from the wheelchair in the corridor to the cubicle for examination. He denies any other injury.

You take a SOCRATES history:

  • Site: Anterolateral part of the ankle
  • Onset: Sudden
  • Character: Constant ache with sharp pain on weight bearing
  • Radiation: Nil
  • Associated symptoms: Swelling
  • Timing: Constant
  • Exacerbating/relieving factors: Worse on weight-bearing
  • Severity: 6/10 at rest, 8/10 on weight-bearing

On examination, you note swelling on the anterolateral part of the left ankle joint with tenderness in the same area. He has no tenderness at the posterior edge of the lateral and medial malleoli, at the base of the 5th metatarsal, or the navicular bone. He can dorsiflex and plantarflex the ankle with pain. Ipsilateral knee joint examination is normal. An X-ray was ordered by triage:

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