What is included in the initial care of tibia and fibula fracture in the emergency department (ED)?

Updated: Nov 30, 2017
  • Author: Jeffrey G Norvell, MD, MBA, RDMS; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

When examining a patient for a lower leg fracture, one should first examine the patient for edema, ecchymosis, and point tenderness. Gross deformities should be noted and splinted. Perform radiographs of the knee, tibia/fibula, and ankle as indicated. A careful neurovascular assessment should be performed, and an emergent fracture reduction should be performed if neurovascular deficits are present. A careful examination should be performed for open wounds. Open fractures require antibiotics and an emergent orthopedic consultation.

Tetanus vaccination should be updated, and appropriate antibiotics should be given in a timely manner. Some recommend antibiotics within 3 hours of the accident. [1]

In a study of compartment syndrome associated with tibial fracture, the odds of compartment syndrome increased by 1.67 per 10% increase in the ratio of fracture length to tibial length when considering all fractures. Compartment syndrome was most likely to occur with plateau fractures, at 12% (shaft fractures, 3%; pilon fractures, 2%). [6]

See the fracture image below.

Shown is an intra-articular fracture of the medial Shown is an intra-articular fracture of the medial condyle of the tibial plateau.

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