Rosh Emergency Medicine Practice Test

What is the most important step in the management of a bimalleolar ankle fracture-dislocation for long-term recovery?

1. Intravenous antibiotics

2. Irrigation of the wound

3. Reduction and splinting of fracture-dislocation

4. Time to the operating room

The correct answer is: Reduction and splinting of fracture-dislocation

In managing a bimalleolar ankle fracture-dislocation, the most crucial step for long-term recovery is the reduction and splinting of the fracture-dislocation. Proper alignment of the fractured bones is essential to restore mechanical stability, facilitate healing, and prevent complications such as malunion or nonunion. Reduction involves realigning the fractured and dislocated joint to restore normal anatomy, which is vital for preserving function and minimizing the risk of post-traumatic arthritis. Splinting provides immediate stabilization, preventing further damage to the surrounding soft tissues while waiting for surgical intervention. Irrigation of the wound and administration of intravenous antibiotics are important but are secondary considerations that come into play to prevent infection and manage soft tissue injury after achieving initial fracture stabilization. Timing of the operation is also relevant, but without initial reduction and splinting, the risk of complications increases significantly, making fracture alignment the priority in the acute setting.