mcq on NAME_1 fractures represent a subset of fractures about the
ankle due to a high-energy axial load. They are more
correctly categorized as tibial plafond fractures with a
NAME_1-type mechanism. NAME_1, meaning hammer, defines
fractures sustained from an axial load impacting the
talar body into the distal tibial plafond. These fractures
include combinations of injuries to the tibial articular
surface, the fibula, the tibial metaphysis, and often the
diaphysis. Patients often are victims of motor vehicle
accidents or falls from height. They may complain of
significant pain and swelling with an inability to ambulate. Because of the mechanism there should be a high
index of suspicion for other injuries and potential risks,
including compartment syndrome and compression
fractures of the lumbar spine.
Physical Examination. In the acute setting, patients
will present with a painful, swollen leg with or without
an obvious deformity. It is essential, as with any trauma,
to assess the neurovascular status of the patient. The
amount of swelling, and skin changes, are also important to note. Some patients, as many as 20% to 30%,
may present with an open wound and therefore should
be treated emergently. While assessing the patient it is
important to note whether a deformity is present and
if it is causing any compromise to the neurovascular
structures of the soft tissue. If so, this should be
addressed urgently.
The remainder of the examination is often deferred,
owing to the amount of pain these patients will be
experiencing. In the office setting it is again essential to
document the neurovascular status and to compare this
to the initial examination. Importantly with NAME_1 injuries, the splint or cast should be removed to assess the
soft tissue. This will be critical to surgical planning as
well as to continued immobilization management.