What is included in initial emergency department (ED) care for patients with tibia and fibula fracture?

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

Parenteral analgesia should be administered when appropriate. Although management of pain has improved, pain due to long bone fractures is notably undertreated in the emergency department. [16]  Inpatient admission may be advised to observe development of compartment syndrome. Continuous compartment pressure monitoring in asymptomatic patients with tibia fractures is not recommended. [21]

Open fractures must be diagnosed and treated appropriately. 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] This should involve antistaphylococcal coverage and consideration of an aminoglycoside for more severe wounds. Orthopedics should be consulted for emergent debridement and wound care. Fractures with tissue at risk for opening should be protected to prevent further morbidity. Open fractures require debridement and irrigation in the operating room.

According to one study, delay of the first operative procedure beyond the day of admission appears to be associated with a significantly increased probability of amputation in patients with open tibia fracture. In this study, data were analyzed from the Nationwide Inpatient Sample, 2003 to 2009. [22]


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