Copyright (c) 2010 Julie Glynn

It is very important that the full extent of lower limb injuries is properly diagnosed. Injuries to the bone are normally identified by x-rays but this will not diagnose the severity of associated soft tissue damage which will also often be present. It is also important to understand and recognise the severity of any contusion or crush injury to the tissue as surgical procedures through this tissue can lead to poor wound healing with a risk of infection.

The nature and severity of fractures depends upon the structure and integrity of the bone which has been affected together with the degree of force which has been applied to it. The integrity of the bone is important as anything which compromises this predisposes the limb to fracture, for example osteoporosis.

It is also important to consider the external force which has been applied to the limb and the direction of application of that force. For long bone fractures four basic fracture patterns are as follows:-

- Compression force - short/fracture;

- Tension force - transverse fracture;

- Twisting force - spiral fracture;

- Bending force - butterfly transverse fracture.

Accurate assessment of the injury is most important to decide on treatment management for lower limb trauma. The neuro-vascular function of the injured limb should be assessed and documented and a close inspection undertaken of the overlying soft tissues to address the degree of damage. X-rays are a bare minimum requirement to assess an injured limb.

Complex fractures usually will require more sophisticated imaging including CT and MRI scanning. Of course, this can lead to a delay in treatment but it is preferable for there to be a slight delay rather than poor treatment resulting from an inadequate assessment of the injury. The treatment options for lower limb fractures are variable.

Conservative management usually involves closed techniques such as traction slings and plaster casts. The vast majority of fractures managed in the United Kingdom are treated conservatively as out-patient injuries.

Operations are usually required for articular fractures and displaced long bone fractures. The alternatives include internal fixation with plates and screws or intra-medullary nails, or external fixation.

The complications of lower limb trauma include Fat Embolism Syndrome, Thromboembolic Disease and, in severe cases, multi system organ failure. More local complications include soft tissue and vascular insufficiency, osteomyelitis and infection as well as Compartment Syndrome and malunion and non-union of the fracture.

With Compartment Syndrome early recognition is essential to ensure the maintenance of function through an immediate fasciotomy to release the fascial envelopes to decrease the pressure within.

Summary.

If you have suffered a lower limb injury was it properly assessed? If not, is there anything you can do about it? Speak to a specialist medical negligence solicitor and they will be able to advise you of the options available to you.