September 29, 2009

Right lower limb pain after accident

A 39 years old Malay lady was fetch by EMD after involve in motorcycle accident. Patient complaint of pain and unable to move his foot. The picture shows the right lower limb of the patient together with her lower limb x-ray.

1) Explain your findings
2) What is your diagnosis
3) Name one classification used to grade this condition
4) What is complete management for this patient?


  1. Salam, saya try soklan senang dulu ye..

    Ini macam fibia n tibula bone fracture on patient right leg.

    apa beza finding dengan diagnosis dalam kes ini?

    classification used to grade saya tataw. saya cuba cari..

  2. wsalam.. cuba lagi k. you got the sense but it just not complete.

    whenever we describe fracture in x-ray always remember to mention which side of the lesion, what type of the fracture? is it simple vs compound. what bone involve and at which site? it is shaft, head, articular vs non articular. is it transverse or spiral and many more.

    well, finding is what you see on the picture based on these two picture.

    diagnosis is your final assesment on that patient. what actually he suffered from..

    for the grading, use the first picture as reference. look carefully and think why i put it there..

    give a best shot again. dont give up

  3. thank you for further explanation..

    sorry for taking so long to reply this. After I did some reading, here is some additional answer.
    I won't give up, and will try my best.. =)

    1.Its is compound fracture (open) involve wounds.
    Simple fracture because the bone broke into two pieces.
    Complete fracture because bone fragment separate completely.

    Bone involve is tibia and fibula.
    Site of fracture is at shaft.

    2. Bone fracture? Still dunno.. +_+

    3. OTA : Orthopedic Trauma Association?

    4. For management, usually bone fracture treated by immobilization, but in this case it is less likely. Bone should be reinforce by metal in surgery.

    hmm, patient will likely to get systemic infection, therefore antibiotic (prophylactic) should be given.

    ="p I'm trying my best since i never learn this type of injury yet..

  4. Assalam. I'm a fifth year medical student going for his final professional exam next year. Sorry to interrupt, as I have recently gone into this website this year. However, I shall try as well.

    1. Figure 1 shows an open wound injury over the distal 1/3 of the right leg and above the ankle. Size of the wound is assumed to be more than 1cm in length and width. No appreciable contamination.

    Figure 2 shows an AP view X-ray of the right leg showing oblique (simple) fracture of the right tibia and fibula with shortening, shifting to the right (lateral) and about 20 degrees angulation. Soft tissue injury is seen in the X-ray as well. No evidence of osteoporosis.

    2. Open distal 1/3 tibio-fibular shaft fracture

    3. Gustilo-Anderson classification of Open Fracture

    4. Management:
    i. Primary and Secondary Survey for any associated injuries, with adjunct investigations
    ii. Immobilisation of the affected limb.
    iii. Wound cleaning and dressing
    iv. Antibiotic prophylaxis with 2nd generation cephalosporin (Cephalexin)
    v. ATT (Anti-tetanus toxoid) prophylaxis
    vi. Gain consent for emergency wound debridement and external fixation.
    vii. ECG, chest X-ray and blood tests for co-morbidities and for blood transfusion (Group Cross matching)
    viii. Arrange for emergency wound debridement and external fixation with wound irrigation using 6L of NS
    ix. Admission to the orthopaedic wards for monitoring of patient's condition.
    x. Monitor for any changes leading to compartment syndrome.
    xi. Gain consent and arrange for open reduction internal fixation (ORIF) with intramedullary nail and cast application post-surgery
    xii. Keep patient non-weight bearing
    xiii. Arrange for physiotherapy intervention.
    xiv. Arrange follow-up with patient for monitoring union of the fracture site

    Please do tell if there's anything I have mistaken or missed out. Thank you. Assalam =)


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