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Year |
2001 |
|---|---|
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Question Number |
85 |
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Category |
Select |
Question
An 11 year-old girl sustained an inversion sprain to the left ankle 12 weeks ago and is unable to bear weight on it. Examination reveals diffuse hypersensitivity. The foot has a purple hue an is diffusely swollen. A bone scan shows diffuse uptake around the hindfoot. Management should consist of :
1. Triple arthrodesis
2. a below-knee walking cast
3. crutches and no weight bearing.
4. sympathetic nerve blockade and physical therapy
5. narcotic analgesics.
Figures
Answer (click for answer)
The correct answer is 4. The diagnosis of RSD may be suggested in the posttraumatic or post-surgical setting when the magnitude of the subjective complaints seems to be discordant or out of proportion to the objective findings. Swelling, stiffness, and discoloration may accompany and also be out of proportion to that expected with the trauma or disease. The use of 3-phase radionuclide bone scanning has been reported to be extremely sensitive in establishing the diagnosis of RSD of the foot. Early recognition of the diagnosis and institution of treatment are critical.. Presumably with early recognition and treatment, the course of the disease may be altered so that the degree of symptoms is decreased and irreversible trophic changes can be lessened or avoided. A multidisciplinary approach that includes the use of physical therapy, pharmacotherapy, and sympathetic blocks should be instituted. (OKU, Foot and Ankle II)
Reference: Mizel MS, Miller RA, Scioli MW (eds): Orthopeadic Knowledge Update:Foot and Ankle 2. Rosemont IL, American Academy of Orthopaedic Surgeons, 1998, PP 108-110.