Assessing and Assessing and Treating Lower Leg Treating Lower Leg

InjuriesInjuries

Lower ExtremityLower Extremity

• Foot• Ankle• Tib-Fib• Patella• Distal Femur

Patient PresentationPatient Presentation

Things to look for ---Things to look for --- ABCs, shock signs, painABCs, shock signs, pain Patient positionPatient position Is patient supporting the Is patient supporting the

leg? Where? How?leg? Where? How? Is the leg Rotated? Is the leg Rotated?

Angulated? Any obvious Angulated? Any obvious deformities? deformities?

Will realignment be Will realignment be necessary for splint?necessary for splint?

Mechanism of InjuryMechanism of Injury “Direct Blow”“Direct Blow”

Mechanism of InjuryMechanism of Injury“Twisting Mechanism”“Twisting Mechanism”

Basic TreatmentBasic Treatment

CMS before and after splintingCMS before and after splinting Assess for DCAP-BTLS/ Go To SkinAssess for DCAP-BTLS/ Go To Skin

(no unnecessary movements)(no unnecessary movements) Cover any open wounds with sterile dressingCover any open wounds with sterile dressing Splint - Stabilize/support the injury Splint - Stabilize/support the injury

(NO LEVERS!)(NO LEVERS!) Emergency Transport if CMS compromisedEmergency Transport if CMS compromised Typically remove boots in aid room, not on ski Typically remove boots in aid room, not on ski

slopeslope

Foot InjuriesFoot Injuries Heel bone most common Heel bone most common

on square landing from on square landing from heightheight Terrain park jumpTerrain park jump Big Air miscalculationBig Air miscalculation

Strong force can be Strong force can be transmitted to spinetransmitted to spine

Boot acts as splint, but Boot acts as splint, but watch for swelling watch for swelling (loosen if numb); elevate (loosen if numb); elevate foot of sled 6”foot of sled 6”

Ankle InjuiresAnkle Injuires Sprain and fracture/ Sprain and fracture/

dislocation dislocation hard to hard to distinguishdistinguish

““Fractured Ankle’ Fractured Ankle’ most likely is fracture most likely is fracture of lower end of tibia of lower end of tibia and/or fibula (pilon fx)and/or fibula (pilon fx)

More common in More common in snowboarders when snowboarders when toe edge catches & toe edge catches & fall forwardfall forward

Consider packing iceConsider packing ice

Tibia & FibulaTibia & Fibula Common in skiing as Common in skiing as

“boot top” and “spiral”, but “boot top” and “spiral”, but also impact fracturealso impact fracture

If both fractured, distal If both fractured, distal part likely angulated or part likely angulated or rotated; must align for rotated; must align for splintsplint

Tibia fractures more likely Tibia fractures more likely to be “open”to be “open”

Leave boot on unless Leave boot on unless excessive bleedingexcessive bleeding

Watch for “lever”Watch for “lever”

Knee InjuriesKnee Injuries

Dislocated Patella

Knee InjuriesKnee Injuries Sprain/Tear Knee LigamentsSprain/Tear Knee Ligaments

Common in skiers, with bending or twistingCommon in skiers, with bending or twisting Did you hear a pop? A fall is not necessaryDid you hear a pop? A fall is not necessary Complete ligament disruption Complete ligament disruption knee dislocation knee dislocation

- popliteal artery compromise (CMS), severe pain, - popliteal artery compromise (CMS), severe pain, not move jointnot move joint

- splint in position found- splint in position found

Fracture/Dislocation of PatellaFracture/Dislocation of Patella Splint in position found, from hip to ankleSplint in position found, from hip to ankle May require flag or cardboard other than quick splintMay require flag or cardboard other than quick splint Pad/Support splinted leg in sledPad/Support splinted leg in sled

Posterior FemurPosterior Femur VERY important to get location correct; VERY important to get location correct;

bottom 1/3; NOT midshaftbottom 1/3; NOT midshaft

Easy to confuse with ligament tear or displacementEasy to confuse with ligament tear or displacement Serious injury since jagged edges can injure nerves and blood vesselsSerious injury since jagged edges can injure nerves and blood vessels Check often for CMSCheck often for CMS Splint from groin to ankleSplint from groin to ankle

Lower Leg Treatment SummaryLower Leg Treatment Summary

Fracture LocationFracture Location SplintSplint

FootFoot Quick SplintQuick Splint

AnkleAnkle Quick SplintQuick Splint

Tibia and/or FibulaTibia and/or Fibula Quick SplintQuick Splint

Straight KneeStraight Knee Quick SplintQuick Splint

Bent KneeBent Knee Multiple methodsMultiple methods

Distal FemurDistal Femur Quick SplintQuick Splint