Page 154 - ASOP Orthopedic Casting Manual

3.6.2 Clinical Characteristics

Clinic al Characteristics / Presentation
✓ Pain and swelling loc alized to the injured region
✓ Defor mit y (if displaced fractures are present)
✓ Inabilit y to be ar weight in lower leg fractures or Achilles tendon ruptures
✓ Instabilit y in ligamentous injur ies
✓ Neurovascular assessment is crucial to rule out comp ar tment syndrome

Fracture Diagnosis Process
1. Physic al Examination

• Assess for defor mit y, swelling, and bruising
• Palp ate for bony tender ness and soft tissue injur y
• Check distal neurovascular function (c apillar y refill, pulses, and sensation)

2. Imaging Studies
• X-ray LAP, lateral, oblique views of the lower leg, ankle, or foot)
• Ul trasound for Achilles tendon rupture
• MRI if ligamentous or soft tissue injur ies are suspected

Differential Diagnosis / Associated Injuries

• Comp ar tment syndrome (c an develop after tibial fractures)
• Tendon injur ies LAchilles rupture vs. severe strain)
• Lisfranc injur ies (midfoot instabilit y)
• Severe ankle sprains with syndesmotic involvement

Tre atment / Management Considerations

• Temporar y immobilization with a poster ior r igid splint for acute fractures or severe soft tissue injur ies before
definitive tre atment.
• Achilles tendon rupture → Immobilization in 20]30 degrees of plantar flexion before or thopedic refer ral.
• Severe ankle sprains → Splinting with non-weight-be ar ing status for 1]2 weeks, followed by progressive
rehabilitation.
• Postoperative immobilization → Used to protect surgic al rep airs while allowing swelling to subside.

Conclusion

The poster ior r igid splint ser ves as an essential temporar y immobilization tool for managing acute lower ex tremit y
injur ies. Unlike circumferential c asts, it allows for swelling accommodation while providing adequate stabilit y.
Ear ly applic ation, proper positioning, and c areful monitor ing are essential to prevent complic ations, including
comp ar tment syndrome and neurovascular compromise. Once swelling subsides, p atients are transitioned to
definitive tre atment, which may include c asting, functional bracing, or surgic al inter vention, depending on the
sever it y of the injur y. Proper p atient educ ation on weight-be ar ing restr ictions and follow-up c are ensures optimal
outcomes and minimizes long-ter m complic ations.