A step away from disaster

In September 2025, a 65-year-old Brazilian national travelling from Spain presented to the emergency department of Private Versa Hospital in Nevşehir, Turkey, following a fall. What followed was a fully coordinated international assistance operation managed end-to-end by Eagle Group – from first alarm to final case closure.

On arrival, clinical findings were immediate and concerning: significant swelling, ecchymosis, and tenderness across both malleoli of the right ankle, with pain on movement and visible deformity on plain radiograph. CT scans confirmed a trimalleolar fracture – simultaneous fractures of the lateral malleolus of the fibula, the medial malleolus, and the posterior malleolus of the tibia – accompanied by ankle subluxation. Closed reduction and short-leg splinting were applied as stabilisation while surgical preparation commenced.

Two significant findings

Pre-surgical investigations identified two clinically significant findings. Imaging confirmed an unstable fracture pattern requiring urgent open fixation. A portable chest radiograph additionally revealed right hemidiaphragmatic elevation – a secondary finding requiring documentation and follow-up without causing acute respiratory compromise. Oxygen saturation remained stable at 96%, and the surgical team cleared the patient for theatre the same day.

When a case presents with both an acute orthopaedic emergency and a secondary chest finding, coordination must be clinical as well as logistical – nothing can be overlooked.

Surgical intervention

Surgery proceeded under spinal anaesthesia. The lateral malleolus was reduced and fixed using a lag screw, semitubular plate, and seven cortical screws. The medial malleolus was stabilised with two headless cannulated screws, while the posterior malleolus was secured using a washer cannulated screw directed anteriorto-posterior through the distal tibia. Fluoroscopy confirmed adequate reduction and stable fixation with no syndesmosis injury. A short-leg posterior splint was applied at closure.

Post-operative care and Eagle Group coordination

Post-operative recovery remained stable. Wound care, anticoagulation, antibiotic prophylaxis, and analgesia were maintained. Follow-up imaging continued to demonstrate diaphragmatic elevation, and thoracic CT evaluation was scheduled for completion after return home.

Before repatriation, Eagle Group coordinated supervised recovery and early physiotherapy focusing on circulation support, assisted mobilisation, and prevention of post-operative stiffness. Functional assessment confirmed safe mobility with support and readiness for travel once medically cleared.

Eagle Group managed guarantee of payment, insurer reporting, and discharge planning. A fully translated medical file – including operative notes, imaging, laboratory results, prescriptions, and chest findings – was transmitted to the patient’s physician in Brazil.

Medical clearance and repatriation

Following clinical reassessment, the treating orthopaedic team issued a fitto-fly (FTF) certificate confirming medical stability for air travel. Eagle Group then arranged the international return journey, including wheelchair assistance, airport medical coordination, suitable cabin seating, and continuous travel monitoring to ensure a safe transfer to her home country.

Rehabilitation, follow-up, and case closure

Upon arrival in Brazil, the patient transitioned directly into a rehabilitation programme where structured physiotherapy – progressive ankle mobilisation and graduated weight-bearing – began within 48 hours. Two-week orthopaedic review confirmed satisfactory healing and stable fixation. Thoracic CT evaluation was completed locally, with results communicated through Eagle Group’s medical coordination channel.

The case concluded at eight weeks with full clinical reporting submitted to the insurer, demonstrating successful surgical recovery, coordinated rehabilitation, and safe international repatriation.