Case of the month #10: Phantom pain following trauma

Published: 01/12/2021


Mr S is a 55-year-old gentleman.  He was involved in a road traffic accident where he was driving and involved in a head on collision with a car overtaking on a single lane carriageway.  The other driver sadly died and Mr S ended up with multiple injuries including fractured ribs, fractured wrist and a comminuted open fracture of the right ankle.

After a lengthy stay in hospital during which Mr S underwent multiple surgical operations on the complex fractured ankle, he was discharged home.  Six months post-accident Mr S was still reporting severe pain in his right ankle and had been seen on several occasions in the outpatient orthopaedic department. Radiological imaging was still showing non union and despite multiple attempts at surgical fixation, the joint was still unstable. Mr S was also reporting ongoing severe pain including pain at night. He was unable to weight-bear and confined to using a wheelchair as he found crutches difficult to use due to the previous wrist fracture, albeit that this appeared to have healed well.

Options were discussed with Mr S, namely that of being referred to a tertiary centre for more complex surgery or amputation.  Mr S opted for a below knee amputation and underwent an uncomplicated below knee amputation a year following the initial trauma.  He was at this point in time referred to a rehabilitation clinic for a prosthesis.  Mr S however continued to report pain and at this point in time, his GP thought it was a good idea to refer him to the local Pain Clinic. 

  • What questions would you like to ask when you first meet Mr S in your clinic?
  • What measurement tools may be useful on your first and subsequent encounters?
  • What management options might be useful?