Splint first, ask questions later.

Here's a recent film fed back to us from orthopaedics.  They feel (quite rightly) that something should have been done before this X-ray was taken.  Given that there is no dislocation, and no skin compromise, what obvious clinical finding should have prompted us to manipulate first?


What condition can complicate this fracture after reduction +/- surgery

The knee is an AP and the ankle is a lateral - this patient's foot is clearly pointing the wrong way. This fracture pattern is grossly unstable, and will wobble freely on the way to and from X-ray. From an analgesic point of view, even placement in a box splint would greatly improve patient comfort. It's a pre-hospital standard of care, so it should certainly be met in hospital.


For a summary of fracture patterns around the ankle and tib/fib, follow these links.


Compartment syndrome.  Just to confirm, it is happening LONG before the pulses go, by which time you've missed the diagnosis.  Summary article here.