If it’s a fracture, it might need a cast
In an ankle that swells up so fast.
The problem might be
It’s come up low in the past
After eight weeks work and four weeks vacation in Alaska, I’m back in Sioux City. Prior to this absence I’ve not been gone from home more than eighteen days running, and never more than six weeks in a year.
My body doesn’t handle the late August heat like it has in years past, and I still reach for a coat before I go outside, even if the weather is hot.
In the late afternoon Bethany and I went to a (literal) Sunday School picnic. People greeted me warmly; I talked about living in Barrow, seeing the sea ice, working with subsistence hunters, being in a place where the roads do not connect with the outside. But I also talked about the vacation and the fishing.
I felt a hand on my elbow while recounting my experiences. A close friend and good neighbor asked that I have a look at his child’s ankle, following a fall.
I’m conscientious about honoring my non-compete clause, but I saw the situation as a clear-cut Good Samaritan action.
We walked over to the car, where I found the child well buckled up and clearly in pain.
I saw obvious swelling at the front of the upper ankle; the kid was exquisitely tender there.
I said that the ankle was almost certainly fractured, and I advised elevation, ice and avoidance of weight-bearing until x-rayed.
A good amount of research has been done trying to determine when to and when not to x-ray a traumatized ankle. Sudden, rather than delayed swelling frequently indicates a broken bone. The severe swelling made me reasonably sure of a fracture.
One of the child’s relatives called me three hours later; I’d diagnosed well, I heard, the tibia (shin bone) was broken near the ankle.
I called the parent, who gave me permission to write about the incident. Make sure that the kid gets a 25-OH vitamin D level, I said; a fracture like this isn’t normal.
I didn’t mention the high prevalence of vitamin D deficiency.