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Fractured tib/fib

Image by Jon Yates, on flickr

Image by Jon Yates, on flickr

It was a cold and dark evening when the call came in – ‘RTC car vs pedestrian’; luckily I was only a minute away and arrived while the caller was still on the telephone giving details to the ambulance service. At first glance, there was the usual array of bystanders milling about the scene; The car was sitting awkwardly in the centre of the road and lying in front of it, the unfortunate pedestrian. Reassuringly I could immediately see that he was conscious and talking.

The rain started to drizzle (again) as I pulled various bags from the car and walked towards the crowd. Bystanders had piled coats on top of the patient to keep out the bitter cold and one was directing traffic in the now–single lane street; another was kindly supporting the distressed driver of the car. They were a particularly organised group of bystanders – it seemed to me as if they had just come from a course on the subject as they appeared so coordinated; although seemingly none knew the other before the accident.

My young patient, whom I shall call Michael, was leaning up on one elbow. He looked about twenty years of age. As I approached, he begged me to look at his leg. I made a rapid assessment of his head, neck and chest, and as he had no other pain or priority symptoms I moved down to have a look at his leg.  A small puddle of blood was already forming around his foot. I cut his track suit trouser up to the thigh to see clearly what injury he had, and immediately it was obvious that he had sustained a particularly nasty fracture. The two bones of his lower leg (tibia and fibula) were sticking right out through the skin – their whiteness glistened blue intermittently as the flashing lights from my car reflected on them; the lower half of his calf was bent off at an impossible angle. At that moment Michael looked me in the eyes and pleaded:

“It’s not broken is it? – I am an athlete and I’m joining the army soon.”

My heart went out to him as I knew realistically that it was unlikely he would be doing that anytime soon. I think I said something vaguely reassuring about how, yes, it was broken but nothing that couldn’t be sorted, as I started to prepare the pain-killers he needed. It would definitely too painful to move him before they were in his system. At that point an ambulance turned up and we worked together giving him intravenous painkillers as well as gas and air (Entonox); when we straightened his leg and put it in the splint he barely seemed to notice thanks to the analgesia! We placed him on an orthopaedic stretcher and warned the hospital that we were on our way, so they could prepare for his arrival and treat his injuries promptly.

I popped in to A&E to see how Michael was doing a little later, thankfully he was comfortable and very drowsy; his leg had been placed in a temporary plaster cast while he waited for the operation to fix it. I will probably never know the final outcome for Michael, which is a frustrating situation but it is something we get used to with our job.

Ever got involved when you’ve witnessed an incident in a public place?  Did your instincts take over or did you feel very helpless?  Leave me a comment below.

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