Q: Write a full medical record of the patient nguyễn đức long . . I have uploaded a pdf doc which is the patient case record. Now I want to write the case record in the format that I typed below :ORTHOPAEDIC CASE RECORD TEMPLATE I.ADMINISTRATIVE INFORMATION 0.25 pts II. CLINICAL CONTENT: 1. Reason for admission 0.25 pts: The primary reason for the patient's admission 2. History of present illness 0.5 pts: Present all three key elements: mechanism of injury; symptoms following the injury; and first aid/initial management before hospital admission. 3. Past medical history 0.25 pts - Comorbidities - Habits/risk factors related to the primary condition or to the patient's treatment course - Residual impairments of the musculoskeletal system 4. Condition on admission 0.25 pts - Level of consciousness - Vital signs - Key physical findings documented on admission DEPENDING ON WHETHER THE PATIENT HAS ALREADY RECEIVED DEFINITIVE TREATMENT, THE STUDENT SHOULD SELECT THE APPROPRIATE CASE-RECORD FORMAT PREOPERATIVE 5. Ward course 0.25 pts: Summarize changes in symptoms and the management provided 6. Current condition 0.25 pts: Current symptoms 7. Clinical examination 2 pts a. General examination b. Systemic examination 8. Case summary 1 pt: Summarize physical findings and symptoms into symptom/sign groups or clinical syndromes Examples: - Definite signs of fracture: - Signs of compartment syndrome: - Radial nerve palsy syndrome:... 9. Diagnosis 0.5 pts: State the primary injury, associated complications if any injuries, and/or 10. Diagnostic reasoning 1 pt: Explain the basis for the diagnoses listed above 11. Recommended investigations 0.5 pts: Select appropriate investigations according to the site of injury Examples: AP pelvic X-ray: AP and lateral femur X-rays; three-view calcaneal X-rays: etc. Interpret the results of all available investigations. 12. Definitive diagnosis 1 pt: State the primary injury and classification, together with associated injuries and/or complications if any 13. Treatment: a. Treatment plan 0.25 pts: Propose an overall treatment plan. Examples: analgesia, antibiotics, surgery, etc. Note: For the Basic Surgery course, the assessment may end here. Points assigned to the sections below will instead be redistributed to clinical examination +1 pt, diagnosis +0.5 pts, and treatment plan +0.25 pts. b. Specific treatment 0.5 pts: Based on the treatment plan, provide the specific treatment regimen. Example: - Paracetamol 0.5 g, 1 tablet orally three times daily every 8 hours. Open reduction and internal fixation with a locking plate and screws. Explain the rationale for selecting the above treatment method 0.25 pts 14. Prognosis 0.5 pts Short-term: Based on the patient's clinical findings and investigations, predict potential problems during hospitalization,preoperative, intraoperative, and postoperative. Example: The patient has diabetes mellitus and therefore has a higher risk of postoperative infection. A complex fracture may prolong surgery, increase blood loss, and raise the risk of infection. Long-term: Functional recovery and potential late complications or sequelae related to the injury. Example: Early knee osteoarthritis may develop because a complex articular injury is difficult to reduce anatomically. 15. Preventive measures 0.5 pts: Propose measures based on the prognosis to prevent complications. Example: Optimize glycemic control to reduce the risk of surgical-site infection. Plan the operation, prepare all required instruments, select an experienced surgeon, and arrange blood products in advance to mitigate prolonged operative time and blood loss in complex fractures. POSTOPERATIVE 5. Clinical diagnosis 0.25 pts 6. Investigations and results 0.25 pts: Interpret the X-ray findings; describe the fracture location and pattern and any displacement; then provide a conclusion, including fracture classification. 7. Definitive diagnosis 0.25 pts: State the primary injury, associated injuries, and/or complications if any Surgery was indicated for the patient: 8. Operative report if surgery was performed 0.25 pts: Preoperative and postoperative diagnoses Operative duration Estimated blood loss if anyrecord or by asking the surgeon Operative procedure from the medical Other intraoperative events blood transfusion, adverse events/complications, etc. 9.Postoperative/post-cast course 0.25 pts: Describe symptoms only. 10. Clinical examination 1.5 pts: a. General examination b. Systemic examination Postoperative/post-cast follow-up X-rays 11. Case summary 1 pt: 12. Conclusion 0.5 pts: Provide a complete statement of the diagnosis, treatment method, and current outcome Example: Postoperative day 3 after locked intramedullary nailing for a closed fracture of the middle third of the right femoral shaft; clinical course is stable. 13. Further treatment a. Treatment plan 0.25 pts: Propose the ongoing treatment plan Examples: analgesia, antibiotics, surgery, etc. Note: For the Basic Surgery course, the sections below may be omitted except for Comments. Points assigned to the omitted sections will instead be redistributed to clinical examination +1 pt, diagnosis +0.5 pts, and treatment plan +0.25 pts. b. Specific treatment 0.5 pts: Based on the treatment plan, provide the specific treatment regimen. 14. Prognosis 0.5 pts Short-term: Potential problems during hospitalization and the patient's expected ability to perform daily activities and ambulate. Long-term: Bone healing, rehabilitation, and potential late complications or sequclac. 15. Preventive measures 0.5 pts: Propose measures based on the prognosis to prevent complications 16. Comments 0.5 pts: Assess whether theoretical knowledge is consistent with the patient's actual course, from the time of injury to the time of examination.Example: The mechanism of injury is consistent with the fracture pattern. Initial management was inappropriate because the injured limb should have been immobilized at the scene. Surgical management may not have been indicated; for simple, nondisplaced fracture, conservative treatment would theoretically provide greater benefit. A: --- ORTHOPAEDIC CASE RECORD Can Tho University of Medicine and Pharmacy Hospital Department of Orthopaedics, Trauma, and Spine Surgery --- I. ADMINISTRATIVE INFORMATION Field Details ------ Full name NGUYEN DUC LONG Date of birth 16 September 1989 Age 37 years Sex Male Ethnicity Kinh Occupation Unspecified construction worker Address Quang Dong Commune, Nghe An Province Health insurance number DN4790112057344 valid to 31/12/2026 Admission number 116056 PID: 26072400 Date and time of admission 08 July 2026, 15:47 Admitting department Emergency and Intensive Care Unit Current ward Orthopaedics, Trauma, and Spine Surgery Room 36, Bed K24.11.02.HO Next of kin Hoang Minh Tien; Tel: 0339930898; Quang Dong Commune, Nghe An Province Attending physician Ths. BS. Truong Ngoc Thach initial; TS. BS. Tran Nguyen Anh Duy ward --- II. CLINICAL CONTENT 1. Reason for Admission Left ankle injury sustained at a construction worksite on 08 July 2026, with ankle deformity, limited motion, an open wound over the medial aspect of the ankle, and absent dorsalis pedis pulse on the left side. --- 2. History of Present Illness Mechanism of injury: On 08 July 2026 the same day of admission, while working at a construction site, the patient's left lower extremity was caught in a rotating concrete mixer drum. The mechanism involved a high-energy rotational and compression force applied to the left ankle and foot complex. Symptoms following injury: Immediately after the incident the patient noticed severe pain over the left ankle region, visible deformity of the ankle and foot, markedly reduced range of motion of the ankle and toes, and a small wound approximately 1 cm in diameter over the medial aspect of the left ankle with minimal bleeding. The dorsalis pedis pulse on the left side was not palpable. Sensation in the left toes was reported as intact; SpO2 of the left foot was 100%. First aid / initial management before hospital admission: No formal pre-hospital immobilisation of the injured limb is documented in the record. The patient was transported directly to the Emergency Department of Can Tho University of Medicine and Pharmacy Hospital on the same day of injury. --- 3. Past Medical History - Comorbidities: Gastro-oesophageal reflux disease GORD/GERD ICD-10: K21 - Habits / risk factors: No drug allergies recorded; no history of tobacco or alcohol use documented - Residual musculoskeletal impairments: None previously recorded --- 4. Condition on Admission - Level of consciousness: Alert, cooperative, oriented GCS 15; "tinh, tiep xuc tot" - Vital signs: - Heart rate: 78 beats/min - Blood pressure: 120/70 mmHg - Respiratory rate: 20 breaths/min - SpO2: 98% room air - Temperature: not recorded - Weight: 60 kg; Height: 165 cm; BMI: 22.04 - Key physical findings on admission: - Skin and mucosa: well-perfused, pink - Left ankle: severe pain, visible deformity angulation of ankle and foot axis, open wound 1 cm over the medial ankle, minimal haemorrhage - Vascular: right dorsalis pedis pulse strong and palpable; left dorsalis pedis pulse absent - Neurology: sensation in left toes intact; SpO2 left foot 100% - Toe movement: diminished active movement of left ankle and foot - Cardiovascular: regular heart sounds, no murmurs - Respiratory: clear air entry bilaterally, no added sounds - Abdomen: soft, non-tender, no localised tenderness --- The patient has already received definitive treatment - POSTOPERATIVE FORMAT applies --- 5. Clinical Diagnosis Provisional - Emergency Department 1. Closed fracture-dislocation of the left ankle ICD-10: T14.3 - Dislocation, sprain and strain of joints and ligaments of unspecified body region, confirmed subsequently as left ankle 2. Open wound of the left ankle penetrating wound, medial, 1 cm, with suspected intra-articular communication - "vết thương nghi thấu khớp" 3. Possible vascular injury - absent left dorsalis pedis pulse 4. Gastro-oesophageal reflux disease K21 --- 6. Investigations and Results Laboratory Results collected 16:06, 08 July 2026 Test Result Reference range Unit ------------ Na⁺ 143.8 134-145 mmol/L K⁺ 3.97 3.4-4.8 mmol/L Cl⁻ 108.0 98-107 mmol/L AST GOT 27 5-34 U/L ALT GPT within normal limits Creatinine within normal limits Urea within normal limits PT Prothrombin time 13.5 seconds 70-120% activity Stago PT ratio 0.96 0.8-1.2 APTT within normal limits Interpretation: Electrolytes within normal range Cl⁻ mildly at upper limit. Renal and hepatic function normal. Coagulation profile acceptable for surgery. No metabolic derangements noted. Imaging Chest X-ray AP view, 08 July 2026: Both lung fields are clear and well-expanded. No consolidation, effusion, or pneumothorax. Heart size within normal limits. Trachea midline. No rib fractures. Mediastinum normal. Diaphragm intact. Conclusion: Normal chest X-ray - no contraindication to anaesthesia or surgery. Left tibia-fibula X-ray AP view, 08 July 2026 - film with backslab in situ: The tibia and fibula shafts appear intact. A plaster backslab is visible encircling the distal lower leg. There is mild soft tissue swelling of the distal leg and ankle. The distal fibula shows a subtle area of cortical irregularity consistent with a minimally displaced distal fibular fracture or early callus. No gross diaphyseal fracture of the tibia. The proximal tibiofibular joint and knee region appear normal. Conclusion: Likely distal fibular fracture minimally displaced with extensive soft tissue swelling; tibia intact at the diaphyseal level. Left ankle X-ray - AP/Mortise view 08 July 2026: Severe comminuted fracture involving the talus with multiple fracture lines through the talar body and neck. Associated fracture fragments at the lateral malleolus distal fibula and irregular bony fragments near the medial malleolus. Marked soft tissue swelling both medially and laterally. Complete disruption of the ankle mortise - the tibiotalar joint space is no longer congruent. Lateral subluxation/dislocation of the foot relative to the tibial axis. The subtalar joint is also disrupted. Conclusion: Complex fracture-dislocation of the left ankle with comminuted talar fracture, lateral and medial malleolar fractures, and disruption of the ankle mortise. Left ankle X-ray - Lateral view 08 July 2026: The talus, calcaneus, navicular, and midfoot bones are visualised. On this view the cortical margins appear relatively smooth. The normal tibiotalar relationship and the medial longitudinal arch are difficult to assess given the degree of injury. No visible posterior malleolar fracture fragment on this projection. Conclusion: Lateral view confirms ankle region injury; complements AP/mortise view findings. Left tibia-fibula AP view post-reduction, with cast: Both tibia and fibula well-aligned within the cast. The proximal tibiofibular joint and knee appear normal. The cast provides circumferential immobilisation. No gross angulation or translation of the tibial or fibular shafts. Conclusion: Satisfactory alignment of the lower leg within the plaster cast post-reduction. --- 7. Definitive Diagnosis 1. Fracture-dislocation of the left ankle - complex comminuted fracture involving the talus, lateral malleolus distal fibula, and medial malleolar region, with dislocation of the tibiotalar joint; associated penetrating wound over the medial ankle open injury 2. Open wound of the left medial ankle - approximately 1 cm, with suspected intra-articular communication 3. Vascular compromise - absent left dorsalis pedis pulse at presentation resolved after closed reduction 4. Gastro-oesophageal reflux disease K21 Surgery was indicated for this patient. --- 8. Operative Report Preoperative diagnosis: Complex fracture-dislocation of the left ankle T14.3 with open wound penetrating wound, suspected intra-articular; vascular compromise absent left dorsalis pedis pulse Procedure performed: 1. Closed reduction and backslab immobilisation of left ankle fracture-dislocation performed in the Emergency Department, 16:10, 08/07/2026 - Anaesthesia: local/regional nerve block gây tê tại chỗ - Technique: longitudinal traction applied along the axis of the left lower leg; reduction confirmed clinically - the ankle joint relocated; dorsalis pedis pulse returned; SpO2 of left foot 100%; left toes warm and pink; active toe movement preserved - Post-reduction: wound irrigated and cleaned; plaster backslab applied in the neutral position - X-ray confirmed: joint reduction achieved 2. Formal surgical procedure: Wound exploration, debridement, wound closure + ligament repair / Fracture-dislocation reduction performed in the operating theatre, 08 July 2026, evening/same day as per ward notes indicating postoperative monitoring from 08/07/2026 onwards - Surgeon: BS. Tran Quang Son - Procedure: "cắt lọc khâu bao khớp + dây chằng chạy sên / trật hổ khớp cổ chân trái" = wound debridement, ankle joint capsule repair, peroneal tendon repair, and definitive management of the left ankle fracture-dislocation - Anaesthesia method: spinal anaesthesia / endotracheal general anaesthesia tê tuỷ sống/mê nội khí quản - as documented in the multidisciplinary team consultation note - Estimated blood loss: not explicitly recorded; intraoperative transfusion not documented - Postoperative diagnosis: "cắt lọc khâu bao khớp + dây chằng chạy sên / trật hổ khớp cổ chân trái" - wound debridement, joint capsule suture, peroneal tendon repair for left ankle fracture-dislocation Intraoperative events: No adverse events or blood transfusion documented. --- 9. Postoperative Course - Postoperative Day 1 09/07/2026, 07:30: Patient alert and cooperative, vital signs stable, wound dressing intact with minimal serous discharge "vết mổ ít dịch thấm băng", active movement of both lower limbs preserved, dorsalis pedis pulse palpable bilaterally, wound dressing changed. Continuing prescribed medications. - Postoperative Days 2-5 10-13/07/2026: Patient alert, vital signs stable, wound dressing shows minimal serous drainage, bilateral lower limb movement maintained, bilateral dorsalis pedis pulses strong. Wound healing progress noted as satisfactory. - Postoperative Day 6 13/07/2026, 07:00: Patient alert, cooperative; vital signs stable; mild wound pain; minimal serous discharge from wound; active movement of both legs intact; bilateral dorsalis pedis pulses strong; heart sounds regular; lungs clear; abdomen soft. - Day of examination 14/07/2026: Patient under ongoing care; prescribed medications continued transition to oral antibiotics commenced. --- 10. Clinical Examination Day of Examination: 14 July 2026 - Postoperative Day 6 a. General Examination - Consciousness and orientation: Alert, fully oriented, cooperative - General appearance: No acute distress; lying in bed with left ankle immobilised in plaster backslab - Nutritional status: BMI 22.04 normal - Skin and mucosa: Pink, warm, no jaundice, no pallor - Vital signs: Heart rate 78 bpm estimated stable, Blood pressure 120/70 mmHg, Respiratory rate 18-20/min, SpO2 98% on room air, afebrile - Lymph nodes: Not documented as enlarged b. Systemic Examination Cardiovascular: Heart rate regular, normal rhythm, no murmurs. Right and left dorsalis pedis pulses both palpable and equal bilaterally left pulse recovered after reduction. Respiratory: Chest wall moves symmetrically. Air entry equal bilaterally. No adventitious sounds. Chest X-ray: normal as described above. Abdominal: Soft, non-tender, no localised tenderness, no organomegaly. Neurological: No focal neurological deficits of the upper limbs or right lower limb. Sensation in the left foot toes intact. Active movement of all left toes preserved. Musculoskeletal - Left Ankle Primary injury site: - Left ankle and distal leg immobilised in a plaster backslab, neutral position - Moderate swelling of the left ankle and lower leg visible at edges of the cast - Surgical wound: sutured wound over the medial left ankle, approximately 1 cm in length plus operative incision; dressing in place with minimal serous drainage - Skin over the left foot: warm to touch, pink colour, capillary refill satisfactory - Neurovascular status post-reduction and surgery: left dorsalis pedis pulse palpable; left toe SpO2 maintained - Active flexion/extension of left toes: present - Active dorsiflexion/plantarflexion of left ankle: not tested immobilised in cast - No signs of compartment syndrome: no tense swelling, no pain on passive stretch, no paraesthesia, no pulselessness beyond the documented recovery Right lower limb: Intact, no swelling, full range of motion, normal neurovascular examination. Postoperative / Post-Cast Follow-Up X-rays - Post-reduction X-ray of the left tibia-fibula AP view with backslab: tibia and fibula well-aligned within the cast, no gross deformity, satisfactory reduction of the lower leg see X-ray description under Section 6 - Post-reduction ankle X-ray: ankle mortise restored; talar body now seated within the mortise; improvement in alignment compared to pre-reduction films --- 11. Case Summary Clinical problem groupings: Group 1 - Signs of fracture-dislocation of the left ankle: - Mechanism: high-energy rotational and compressive force caught in concrete mixer - Visible deformity of the left ankle with axis malalignment of the foot relative to the leg - Severe pain and tenderness over the left ankle region - Markedly restricted range of motion of the left ankle and foot - X-ray confirmation: comminuted talar fracture, lateral and medial malleolar fractures, disruption of the tibiotalar joint mortise with dislocation pre-reduction films Group 2 - Open injury / penetrating wound: - 1 cm wound over the medial aspect of the left ankle - Minimal haemorrhage; suspected communication with the joint space Group 3 - Vascular compromise at presentation: - Absent left dorsalis pedis pulse on arrival resolved after closed reduction - Foot SpO2 maintained at 100% throughout, suggesting partial or collateral perfusion was preserved - Prompt restoration of pulse after reduction confirms the vascular disruption was secondary to displacement rather than a primary vessel transection Group 4 - Comorbidity: - Known GORD requiring ongoing proton pump inhibitor therapy esomeprazole 40 mg daily --- 12. Conclusion Postoperative day 6 following wound debridement, ankle joint capsule repair, and peroneal tendon repair for a complex open fracture-dislocation of the left ankle comminuted talar fracture with lateral and medial malleolar involvement, and disruption of the ankle mortise; initial vascular compromise resolved after emergency closed reduction; clinical course is currently stable with satisfactory wound healing and preserved neurovascular status of the left foot. --- 13. Further Treatment a. Treatment Plan Ongoing 1. Analgesia - continue systemic analgesia for wound and fracture pain 2. Antibiotics - transition to oral antibiotics as per latest drug orders 3. Acid suppression - continue proton pump inhibitor for GORD 4. NSAID - continue celecoxib for pain and inflammation 5. Wound care - daily wound dressing, monitor for signs of infection 6. Limb immobilisation - maintain plaster backslab in neutral position; plan subsequent definitive fracture fixation as clinically indicated 7. Physiotherapy - isometric exercises and active toe flexion/extension exercises within the cast to maintain circulation and prevent muscle atrophy b. Specific Treatment Regimen Drug Dose and Route Frequency --------- Ceftazidime 1 g Tenamyd IV injection 2 vials reconstituted in sterile water for injection Every 8 hours 08:00, 16:00, 23:00 Levofloxacin 500 mg/100 mL Cooper IV infusion at 30 drops/min Once daily 08:00 Amoxicillin/clavulanate 1000 mg Curam Oral - dose per order As prescribed transitioning Paracetamol 10 mg/mL solution 500 mg bag IV infusion Every 8 hours 08:00, 16:00, 23:00 Celecoxib 200 mg Beroxib Oral, 1 tablet Once daily 08:00 Esomeprazole 40 mg Oral, 1 tablet Once daily 08:00 Rationale for treatment choices: - Ceftazidime + Levofloxacin dual antibiotic coverage: The open wound with suspected intra-articular penetration, high-energy mechanism, and construction site contamination place this injury at high risk of polymicrobial infection including Gram-negative organisms and anaerobes. A third-generation cephalosporin ceftazidime combined with a fluoroquinolone levofloxacin provides broad-spectrum coverage. This is transitioned to oral amoxicillin/clavulanate as the wound improves. - Paracetamol IV + Celecoxib multimodal analgesia: Combining a non-opioid analgesic paracetamol with a COX-2 selective NSAID celecoxib achieves effective pain control through different mechanisms while minimising opioid requirements. - Esomeprazole: Indicated for pre-existing GORD and also provides gastroprotection against NSAID-related gastric mucosal injury. --- 14. Prognosis Short-term: - The complex comminuted nature of the talar fracture with intra-articular involvement carries a high risk of avascular necrosis AVN of the talus, given the talus's retrograde blood supply predominantly from the artery of the tarsal canal entering the talar neck. Displacement and comminution at the talar neck level are well-established risk factors for AVN. - Risk of wound infection and osteomyelitis is elevated due to the open nature of the injury, construction site contamination, and high-energy mechanism. - Risk of neurovascular complications re-occlusion of the dorsalis pedis artery, compartment syndrome must be monitored closely, especially within the first 72 hours post-reduction and post-surgery. - Risk of deep vein thrombosis DVT is increased due to injury severity, lower limb immobilisation, and relative inactivity during hospitalisation. - Prolonged hospitalisation is anticipated given the complexity of the injury. Long-term: - Avascular necrosis of the talus: Likely given the severity of the fracture-dislocation; may result in collapse of the talar dome and secondary ankle osteoarthritis requiring further surgery tibiotalar arthrodesis. - Post-traumatic ankle osteoarthritis: Articular cartilage damage from the comminuted intra-articular fracture, even with anatomical reduction, predisposes the patient to early-onset ankle arthritis. - Peroneal tendon dysfunction: Repair was performed but tendon healing may be incomplete, leading to chronic lateral ankle instability or weakness. - Ankle stiffness: Expected after a significant period of immobilisation and joint capsule injury; may require prolonged physiotherapy. - Return to work: Given the patient's manual labour occupation, return to full capacity is likely delayed by 6-12 months or longer depending on complications. --- 15. Preventive Measures Complication to prevent Preventive measure ------ Wound infection / osteomyelitis Continue targeted broad-spectrum antibiotics; strict aseptic wound dressing changes; wound monitoring for signs of infection redness, warmth, purulent discharge, fever; prompt culture and sensitivity testing if infection suspected Avascular necrosis of talus Avoid premature weight-bearing; serial X-ray and MRI follow-up at 6-week intervals to detect early AVN; plan staged surgical management internal fixation with minimally invasive technique if not yet done Deep vein thrombosis / pulmonary embolism Early prophylactic anticoagulation once haemostasis is established; elevation of the limb; active ankle pump exercises and toe movements within the cast; compression stockings on the unaffected limb Compartment syndrome Daily neurovascular checks of the left foot pulse, sensation, capillary refill, toe movement, pain on passive stretch; split cast or windowed cast if swelling increases; urgent fasciotomy if compartment syndrome develops Pressure ulcers / cast sores Adequate cast padding; regular inspection of cast edges; patient education on symptoms of cast pressure numbness, skin breakdown; timely cast change if soiled or damaged Ankle stiffness / muscle atrophy Begin isometric quadriceps and calf exercises from day 1 post-surgery; progress to active-assisted range of motion when clinically appropriate; formal physiotherapy rehabilitation programme GERD exacerbation NSAID use Continue esomeprazole 40 mg daily throughout NSAID therapy; advise patient to take celecoxib with food --- 16. Comments Mechanism of injury and fracture pattern: The mechanism rotational and compressive force from a concrete mixer drum catching the limb is fully consistent with the resulting complex fracture-dislocation pattern. High-energy rotational forces applied to the ankle in a loaded position are well-recognised causes of comminuted talar fractures combined with malleolar fractures and joint dislocation Hawkins-type talar neck injury with associated pilon/malleolar involvement. The mechanism is therefore internally consistent with the radiological findings. Initial management: The lack of documented pre-hospital limb immobilisation is suboptimal. Standard first-aid guidelines require that injured extremities be splinted in the position found before transport, both to prevent further neurovascular injury and to reduce pain. The absent dorsalis pedis pulse at presentation - which resolved after reduction - suggests the talar dislocation had kinking or compression of the dorsalis pedis artery, a potentially limb-threatening situation that could theoretically have been exacerbated by unprotected transport. Emergency management: The decision to perform emergency closed reduction under local anaesthesia in the Emergency Department was appropriate given the absent dorsalis pedis pulse, which constituted a vascular emergency. Restoration of pulse after reduction confirms this was the correct course of action. Post-reduction X-rays and monitoring were performed correctly. Surgical management: The combination of wound debridement, joint capsule repair, and peroneal tendon repair is appropriate for this open fracture-dislocation. For a complex comminuted talar fracture, definitive internal fixation typically with mini-screws or a low-profile plate may be required after swelling subsides; the current management closed reduction + backslab is appropriate as a temporising measure but must be followed by definitive fracture stabilisation and serial imaging to assess for avascular necrosis. Antibiotic regimen: The use of dual IV antibiotics ceftazidime + levofloxacin is justified for this high-risk open joint injury from a contaminated source. However, duration should be guided by clinical response and culture results; prolonged empirical antibiotic use risks selection of resistant organisms. Overall assessment: The theoretical management principles are consistent with the patient's actual documented course. The key area where initial management deviated from best practice is the absence of pre-hospital limb immobilisation. From the point of hospital admission onward, the emergency closed reduction, operative intervention, and postoperative antibiotic and analgesic management are in keeping with current orthopaedic standards for open fracture-dislocation of the ankle. --- Case record compiled on 14 July 2026, Postoperative Day 6. BV Truong Dai Hoc Y Duoc Can Tho.
