Assessing and Treating Lower Leg Injuries

Lower Extremity Foot Ankle Tib-Fib Patella Distal Femur

Patient Presentation Things to look for --- ABCs, shock signs, pain Patient position Is patient supporting the leg? Where? How? Is the leg Rotated? Angulated? Any obvious deformities? Will realignment be necessary for splint?

Mechanism of Injury “Direct Blow”

Mechanism of Injury “Twisting Mechanism”

Basic Treatment CMS before and after splinting CMS before and after splinting Assess for DCAP-BTLS/ Go To Skin (no unnecessary movements) Assess for DCAP-BTLS/ Go To Skin (no unnecessary movements) Cover any open wounds with sterile dressing Cover any open wounds with sterile dressing Splint - Stabilize/support the injury (NO LEVERS!) Splint - Stabilize/support the injury (NO LEVERS!) Emergency Transport if CMS compromised Emergency Transport if CMS compromised Typically remove boots in aid room, not on ski slope Typically remove boots in aid room, not on ski slope

Foot Injuries Heel bone most common on square landing from height Heel bone most common on square landing from height Terrain park jump Terrain park jump Big Air miscalculation Big Air miscalculation Strong force can be transmitted to spine Strong force can be transmitted to spine Boot acts as splint, but watch for swelling (loosen if numb); elevate foot of sled 6” Boot acts as splint, but watch for swelling (loosen if numb); elevate foot of sled 6”

Ankle Injuires Sprain and fracture/ dislocation  hard to distinguish “Fractured Ankle’ most likely is fracture of lower end of tibia and/or fibula (pilon fx) More common in snowboarders when toe edge catches & fall forward Consider packing ice

Tibia & Fibula Common in skiing as “boot top” and “spiral”, but also impact fracture If both fractured, distal part likely angulated or rotated; must align for splint Tibia fractures more likely to be “open” Leave boot on unless excessive bleeding Watch for “lever”

Knee Injuries Dislocated Patella

Knee Injuries Sprain/Tear Knee Ligaments Sprain/Tear Knee Ligaments Common in skiers, with bending or twisting Common in skiers, with bending or twisting Did you hear a pop? A fall is not necessary Did you hear a pop? A fall is not necessary Complete ligament disruption  knee dislocation - popliteal artery compromise (CMS), severe pain, not move joint - splint in position found Complete ligament disruption  knee dislocation - popliteal artery compromise (CMS), severe pain, not move joint - splint in position found Fracture/Dislocation of Patella Fracture/Dislocation of Patella Splint in position found, from hip to ankle Splint in position found, from hip to ankle May require flag or cardboard other than quick splint May require flag or cardboard other than quick splint Pad/Support splinted leg in sled Pad/Support splinted leg in sled

Posterior Femur VERY important to get location correct; bottom 1/3; NOT midshaft VERY important to get location correct; bottom 1/3; NOT midshaft Easy to confuse with ligament tear or displacement Easy to confuse with ligament tear or displacement Serious injury since jagged edges can injure nerves and blood vessels Serious injury since jagged edges can injure nerves and blood vessels Check often for CMS Check often for CMS Splint from groin to ankle Splint from groin to ankle

Lower Leg Treatment Summary Fracture Location Splint Foot Quick Splint Ankle Tibia and/or Fibula Quick Splint Straight Knee Quick Splint Bent Knee Multiple methods Distal Femur Quick Splint