Leg injuries are initially evaluated with a directed history, including the amount and type of violence that occurred. The history may also give clues about nontraumatic soft tissue injuries. On examination, nerves should be evaluated by checking sensation in the web space, lateral heel, and sole of the foot. Motor tests should include the ability to plantar and dorsal flex the foot, as well as to evert the foot. The extent of soft tissue injury is evaluated visually and by palpating the muscle groups. The tibia and fibula should be palpated along their entire lengths. The popliteal, dorsal pedal, and posterior tibial pulses should be palpated. An absent or decreased pulse may indicate the need for urgent fracture reduction and vascular evaluation. Patients with tibial shaft fractures are unable to bear weight or lift their foot off of the cart. Patients with fibular fractures alone are often able to bear weight.
Simple anteroposterior and lateral x-rays of the leg that include the knee and ankle are sufficient to evaluate leg injuries. If ankle or knee injuries are suspected, then further x-ray evaluation is needed. If a tibial shaft fracture is suspected, the leg should be splinted with a radiolucent device to control pain and prevent further soft tissue damage prior to obtaining films. Check pulses, movement, and sensation before and after moving the leg.
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