Image Case for the Trauma Junkies

[Reasonable Rascal]

BACKGROUND

This young man fell from a height of approximately 25 feet. He sustained open tibial and fibular fractures in his left lower extremity. He has no neck pain or other obvious fractures. What is the diagnosis? What other fractures should be considered? What radiographs should be obtained?

Hint

Think about the mechanism of injury.

[WolfBrother]

He sustained open tibial and fibular fractures in his left lower extremity. He has no neck pain or other obvious fractures. What is the diagnosis?
What other fractures should be considered?
What radiographs should be obtained?

Immediate diagnosis - open tibial/fibular fracture left lower leg. Any other will have to wait until patient is stable, x-rays done, examinations done.

Other fractures?
- hip socket area
- compression of spine anywhere from bottom to top. L to C.

Radiographs?
I'd start with the obvious and work up thru the spine to the skull. Basically a full series due to mechanism of injury.

Have to consider soft tissue and organ injury. Falls can cause tears and brusing in a number of places internally.

[oswald1]

Other fx's to be considered are:
-calcaneus/talus
-femoral shaft, inter or subtrochanteric fx, femoral neck
-should also x-ray knee for tibial plateau & distal femur
-must clear c-spine (must be done radiographically in this case since there are distracting injuries even though he has no neck pain)
-AP pelvis (would also show L-spine)

The rule in orthopedics is that you must always x-ray the joints above and below the fracture

[themadmedic]

Have treated several burst and compression fractures of the lower T-Spine and upper L-Spine with just this MOI.

Have to R/O pelvic and hip Fx's.

Already given LE injuries.

Watch his neuro status-closed head injury may not be highly likely if there was no LOC or direct trauma-but if any changes-or recent associated Hx of LOC changes or HA-then consider spinning his gourd.