The patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Oth erwise, he is generally healthy.
View the x-ray taken (Figure 1) and consider what your diag- nosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: January, 2008

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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