Emergency Medicine

Orthopaedic Emergencies 309

Injuries to the Lower Tibia, Ankle and Foot

(i) Look carefully for avulsion of the tibial spine and or

intercondylar eminence, which may indicate a significant

ligamentous injury.

(ii) A horizontal line fluid level in the suprapatellar pouch on the

lateral view indicates a lipohaemarthrosis with an intra-articular

fracture.

6 Request a CT scan to best demonstrate the extent of these fractures.

MANAGEMENT

1 Give the patient analgesics and refer immediately to the orthopaedic team.

INJURIES TO THE LOWER TIBIA, ANKLE AND FOOT

Fractures of the shaft of the tibia

DIAGNOSIS

1 These injuries are often compound and associated with direct trauma.

2 Greenstick fractures in children and stress fractures in athletes are also seen.

3 X-rays should always include the knee and ankle, as well as the shaft of the
tibia.

4 Gain i.v. access and send blood for FBC, U&Es and blood sugar, and cross-
match 2 units of blood in a compound injury.

MANAGEMENT

1 Compound injury
(i) Commence an i.v. infusion of normal saline or Hartmann’s
(compound sodium lactate).
(ii) Give morphine 5–10 mg i.v. with an antiemetic such as
metoclopramide 10 mg i.v.
(iii) Restore anatomical alignment.
(iv) Cover the exposed area with a sterile dressing.
(v) Give flucloxacillin 2 g or cefuroxime 750 mg i.v. and tetanus
prophylaxis.
(vi) Apply a temporary plastic adjustable splint or a long-leg plaster
of Paris backslab from thigh to foot, with the ankle placed at a
right angle, especially when there are other injuries to the chest
or abdomen requiring more urgent care.
(vii) Refer the patient immediately to the orthopaedic team.