A man with a traumatic lower limb injury

Document neurovascular status Splint and realign the limb Wound swab, tetanus immunoglobulins, and intravenous antibiotics within one hour of presentation Photograph the limb/wound Remove gross contamination with a sterile saline wash and cover with saline soaked swab Apply an above knee backslab and request further imaging Refer to orthopaedics for definitive management (washout and debridement of the wound and exposed bone, and surgical fixation). Delayed/mal/non-union Arterial or nerve injury Venous thromboembolic disease Complications of open lower limb fractures include: o Wound infection—acute infection rates in Gustillo type I fractures: 0%, type II:12%, and type III: 50%3 o Osteomyelitis High energy fractures (including open fractures) are also at high risk of developing compartment syndrome.4 Learning points Prompt intravenous antibiotics for open fractures reduces the risk of acute infection and osteomyelitis. [...]details of The BMJ policy on financial interests are here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests Patient consent obtained.