A Fracture-Dislocation of the Ankle

Dr. William E. Simon:  A 55-year-old housewife and antique dealer was transferred from a suburban hospital with a fracture-dislocation of the left ankle. Five days prior to admission the patient had fallen, sustaining a fracture-dislocation and distal fibular fracture (Fig 1). The extremity had been placed in a plaster cast, and an operative reduction was recommended. However, she elected to be transferred to the Massachusetts General Hospital where previously she had received orthopedic care.The patient's history included longstanding exogenous obesity. Five years earlier she had turned her left ankle and suffered a nondisplaced fracture of the distal fibula. The patient had been treated with a plaster cast and regained full motion of the ankle.Physical examination revealed a tremendously obese woman whose left leg was held in a short leg cast. Of note in her general examination were the excessive obesity and the intertriginous skin changes under breasts and