A 40-year-old construction worker is pulled from the rubble after a building collapses and pins his right lower leg. X-rays in the emergency department reveal a comminuted fracture of the right tibia and fibula. The dorsal pedis and posterior tibial pulses are palpable. The patient complains of severe pain that is accentuated with dorsiflexion of the foot. The calf feels tense. What is the appropriate step?
A tense calf with comminuted fractures (fractures exposed to exterior) and pain on dorsiflexion necessitates a fasciotomy because of the very high probability of a compartment syndrome. Arterial injury is possible (but rare) in lower leg injuries if the pulses are palpable.
ORIF of fracture
ORIF of fracture plus three-compartment fasciotomy
Closed reduction and observation
ORIF only if pulses become weak
Trauma