Mckee的高材生讲课图片，说的是一个80岁的老太太踝关节骨折脱位，在急诊室被复位成这个糟糕的样子，24小时后打开石膏，发现内侧骨折块几乎刺破皮肤，延误了手术计划。我经常用这两张图和下面的英文给我手下的住院医师和研究生们讲课（如何做一个合格骨科住院医师）。多年过去了，有些听进去了成了造福一方的名医，比如承德医学院重症创伤骨科的张擎柱副主任；有些尽管凭着关系留在了省级骨科中心，还是每天让患者受罪，每周至少造孽一次，一年造孽多少次，一生造孽多少次？须知因果循环，报应不爽。
The ankle wants to displace laterally here and hence the medial soft tissues are at risk. You can see wound compromise on the medial side, with near open wound and blistering. This is a major issue for this patient that will impact her treatment plan. So please, if you can’t obtain an appropriate reduction, try again. If it fails again then it may need operative intervention to obtain and maintain reduction (internal or external fixation). But leaving it like this for 24 hours should be avoided.
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