OR2.12 | Leg and Foot Fracture Management — Summary & Reflection

KEY TAKEAWAYS

Leg and foot fractures span a wide spectrum of severity. Tibial shaft fractures are classified by Gustilo-Anderson grade when open; management ranges from functional bracing (undisplaced closed fractures) to intramedullary nailing (displaced/open/unstable) to external fixation (Grade IIIB/IIIC). Compartment syndrome is a constant risk and must be assessed with every tibial fracture. Calcaneus fractures result from axial heel loading; Bohler's angle (normal 20–40°) is reduced in displaced intra-articular fractures; the Sanders CT classification guides operative planning. Falls from height mandate X-rays of both calcanei and the lumbar spine. Fifth metatarsal Jones fractures (metaphyseal-diaphyseal junction) require operative fixation due to non-union risk; pseudo-Jones avulsions do not. Lisfranc fracture-dislocation is the most commonly missed foot injury; diagnosis requires weight-bearing views or CT; any displacement >2 mm requires operative fixation; missed injury leads to post-traumatic midfoot arthritis.

REFLECT

A 35-year-old man comes to the emergency department after jumping off a wall approximately 2 metres high and landing on both heels. He has severe bilateral heel pain and cannot bear weight. Radiographs show comminuted bilateral calcaneus fractures with Bohler's angle of 5° bilaterally. While waiting for the orthopaedic registrar to review the foot films, he mentions his back also 'hurts a bit'. Consider: what additional imaging is immediately required and why? What are the long-term functional implications for this patient if the calcaneus fractures are treated non-operatively versus operatively? In a setting with no orthopaedic specialist, what are your responsibilities and what should your referral communication include?