Emergency Procedures: Long Leg Backslab

emergency procedures-long leg backslab

Indications

  • Tibia and/or fibula shaft fractures
  • Knee and patellar fractures
  • Distal femur fractures

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

iEM Image Feed: Plateau Fracture

iem image feed

A 60-year-old man known to have DM type 2 was brought by the family as a camel hit his knee. He was not able to walk on it at the scene and in ED. It was swollen with no open wound.

Tips
Although patients come with isolated injuries, we always have to make sure that they do not have other injury findings. Therefore, approaching systematically to the patient is important. At this moment, please remember primary and secondary surveys of multiple trauma. The animal attacks may create multiple injuries on patients, and they should be evaluated as multiply injured patients. After you ruled our multiple or life, organ, extremity threatening injury, you can deep dive into isolated injuries. In this case, knee injury after a direct hit.

Of course, inspection and palpation are essential in every extremity injury. Evaluating the patient for neurovascular problems and range of motions are applied in almost every extremity trauma. But sometimes, clinical presentations or findings can be subtle and you may need a better tool. In these case, we recommend using Ottawa Knee Rules.

The image shows tibia plateau fracture on AP knee x-ray.

885.1 plateau fracture
885.2 plateau fracture copy

Additional reading

Cite this article as: iEM Education Project Team, "iEM Image Feed: Plateau Fracture," in International Emergency Medicine Education Project, April 7, 2021, https://iem-student.org/2021/04/07/plateau-fracture/, date accessed: December 3, 2022

A 28-year-old man presents to the ED with left ankle pain

by Stacey Chamberlain

A 28-year-old man presents to the ED with left ankle pain after twisting his ankle playing basketball. He is able to bear weight and notes pain and swelling to the lateral aspect of the ankle (he points to just below the lateral malleolus). He denies weakness, numbness, or tingling and has no other injuries. On exam, he is neurovascularly intact. Edema and tenderness are noted slightly anterior and inferior to the lateral malleolus. There is no point tenderness to the distal posterior malleoli bilaterally.

Should you get an X-ray to rule out fracture?

Ottawa Ankle Rule

Pain in the malleolar zone and any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge or tip of the tibia (medial malleolus), OR
  • Bone tenderness along the distal 6 cm of the posterior edge or tip of the fibula (lateral malleolus), OR
  • An inability to bear weight both immediately after the trauma and in the ED for four steps.

Ottawa Foot Rule

Pain in the midfoot zone and any one of the following:

  • Bone tenderness at the base of the fifth metatarsal, OR
  • Bone tenderness at the navicular bone, OR
  • An inability to bear weight both immediately after the trauma and in the ED for four steps.

Case Discussion

In the above case, using either CDR, an X-ray is unnecessary.

Cite this article as: iEM Education Project Team, "A 28-year-old man presents to the ED with left ankle pain," in International Emergency Medicine Education Project, June 10, 2019, https://iem-student.org/2019/06/10/a-28-year-old-man-presents-to-the-ed-with-left-ankle-pain/, date accessed: December 3, 2022