Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy trauma to the right lower extremity. Clinical examination reveals an open wound overlying the tibial shaft with exposed bone fragments. Patient reports severe pain, inability to bear weight, and localized deformity. Neurovascular status distal to the injury site must be documented.
Clinical Examination Findings
Right lower extremity inspection: 3cm laceration over the anterior tibial crest with visible cortical bone. No active pulsatile hemorrhage. Distal pulses (dorsalis pedis and posterior tibial) are palpable and symmetric. Capillary refill < 2 seconds. Sensation intact to light touch in all dermatomes. Motor function: unable to assess due to pain/instability.
Treatment Protocol
Immediate management: Irrigation and debridement of the open wound, administration of intravenous antibiotics (cefazolin/gentamicin), and tetanus prophylaxis. Application of a sterile dressing and temporary splinting for stabilization. Urgent orthopedic consultation for surgical fixation and intramedullary nailing.