A road traffic crash
A 77 year old man presented to the emergency department after being hit by a car that was travelling at 30 miles an hour (50 kmph). A witness said that the car hit the man's left leg and that he fell on to his left side. The man's pulse was 65 beats/min, and his blood pressure was 130/70 mm Hg. His Glasgow coma score was 15/15, and he had obvious deformities to his left leg and upper left arm, although these did not compromise the skin. Plain radiographs of his left leg are shown in fig 1.
Several methods of treatment exist for tibial shaft fractures. No method is uniquely applicable, and treatment should be suited to each individual patient.4
If the fracture is the result of a low energy mechanism and a stable fracture pattern is seen on the initial radiographs then the fracture can be managed conservatively. Most