INJURY SITE	🛠️ TYPICAL MECHANISM	⚠️ PITFALLS / COMPLICATIONS	🏥 ED / MIU / UCC TREATMENT	📅 FOLLOW-UP
# Neck of Femur (NOF) Clinical emergency if <65 yrs	👵 Elderly: fall, unable to WB, leg shortened & externally rotated. 👩 Young: extreme trauma (RTC, fall from height).	🔎 Impacted # subtle → may need CT/MRI. 📄 Always safety-net if discharged with negative XR.	💉 NOF pathway: imaging, analgesia, transfer. 🩺 Fascia iliac block + IV opioids. 📝 Trauma proforma + mental health screen if >65.	🚨 Immediate ortho referral. 📄 Leaflet if discharged with no clear #.
Hip dislocation	🚗 RTC / fall with hip flexed. Leg short, adducted, externally rotated.	⚠️ Acetabular fracture, sciatic nerve injury. Often high-energy trauma → check for other injuries.	🚨 Ortho emergency → reduction (usually in theatre) within 6 hrs.	📞 Immediate ortho referral.
Dislocated THR	🔄 Hip flexion + internal/external rotation. Leg short & rotated.	⚠️ Risk of recurrence. ⚡ Check sciatic nerve function.	👨‍⚕️ Theatre reduction (always if 1st). ED reduction ONLY with GA + consultant approval.	🚨 Immediate ortho referral.
SUFE (children)	⚽ Sport, chronic or acute Salter-Harris I #. 👦 Usually >8 yrs.	🔎 Frog-leg lateral needed (missed on AP). ❗ Knee pain with normal exam = hip pathology until proven otherwise.	🚨 Immediate fixation required.	📞 Immediate ortho referral.
Femoral Shaft	🚗 RTC / fall from height. 👶 Consider NAI in children.	⚡ Pathological site common. 🩸 Risk of arterial injury → check pulses. 📸 XR whole femur to include hip & knee.	🦵 Kendrick splint + IV access. 💉 Femoral nerve block unless contraindicated.	🚨 Immediate ortho referral.
Femoral Condyles	🤕 High-energy injury (frail elderly = low energy).	⚠️ May be associated with knee ligament injury.	🩹 Above-knee backslab. 🔧 Most require fixation. Undisplaced → may treat NWB in AK POP.	🚨 Immediate ortho referral.

📌 Exam Pearls:
– NOF in <65 yrs = 🚨 emergency.
– Always check 👣 neurovascular status.
– SUFE often mimics knee pain.
– THR dislocation = theatre job, not ED unless GA + senior present.
– Native hip dislocation must be reduced <6 hrs to avoid AVN.

🦵 Knee Fractures & Injuries

🔎 Lipo-haemarthrosis on lateral XR = intra-articular injury.
💉 Aspirate for analgesia if tense haemarthrosis.
⚠️ Always check hips & abdomen if knee exam normal.

INJURY SITE	🛠️ TYPICAL MECHANISM	⚠️ PITFALLS / COMPLICATIONS	🏥 ED / MIU / UCC TREATMENT	📅 FOLLOW-UP
Patella #	🤕 Direct blow / sudden quad contraction	🦵 Always test extensor mechanism → SLR / extension from flexion.	🩹 AK backslab. 📸 Skyline view if uncertain (bipartite mimics fracture).	🚨 If displaced / comminuted → immediate ortho. ✅ Undisplaced & extensor intact → fracture clinic.
Patella dislocation	⚽ Lateral displacement after blow or contraction.	👀 May reduce spontaneously. Medial quad tenderness = clue.	🧑‍⚕️ Reduce: extend knee + medial pressure. 🩹 Cylinder cast / cricket pad.	📅 Fracture clinic ± MRI/repair of MPFL.
Quad / Patellar tendon rupture	💥 Abrupt contraction ± blow	🦵 Extensor mechanism lost = no SLR.	📡 USS if uncertain.	🚨 Surgical repair (ortho).
Knee ligaments (MCL/LCL/ACL/PCL)	⚽ Sporting injuries	⚠️ PLCI often associated. Haemarthrosis, capsular or meniscal tears. XR often normal.	🩹 Crutches + analgesia. ✅ Document distal NV status.	📅 Physio at 5–7d or GP referral. 🚨 Ortho if grossly unstable.
Posterolateral corner injury (PLCI)	⚽ Sport / 🚗 RTC / 🤕 fall (hyperextension, anteromedial trauma)	⚠️ Easily missed; can involve nerves + other ligaments.	🧪 Dial test: prone, ER tibia at 30°/90° → >10° difference.	🚨 Immediate ortho referral.
Knee dislocation	🚗 RTA / fall	⚠️ High vascular injury risk → CT angiogram if in doubt.	✅ Full NV exam mandatory.	🚨 Immediate ortho + vascular referral.
Meniscus	🔄 Twisting injury. Bucket handle = springy block to extension.	⏳ May settle in 2–3w, but prone to recurrent locking.	🩹 Crutches + analgesia.	📅 Fracture clinic. 🚨 True locked knee = urgent ortho.

📌 Exam Pearls:
– Patella fracture vs bipartite → Skyline XR.
– Always test extensor mechanism.
– PLCI often missed → Dial test.
– Knee dislocation = vascular emergency.
– Bucket handle tear = true mechanical lock.

🦴 Tibia & Fibula Fractures

INJURY SITE	🛠️ TYPICAL MECHANISM	⚠️ PITFALLS / COMPLICATIONS	🏥 ED / MIU / UCC TREATMENT	📅 FOLLOW-UP
Tibial Plateau	📉 Axial compression / lateral blow.	⚡ Peroneal nerve risk.	🩹 AK backslab. 🖥️ CT usually required. Most → fixation.	🚨 Immediate ortho referral.
Mid-shaft Tibia	💥 Blow / torsion.	⚠️ Compartment syndrome.	🩹 AK POP (split). 💉 Analgesia. 🚑 Open # → trauma centre.	🚨 Ortho referral, monitor for compartment syndrome.
Toddler’s # Undisplaced spiral, <7 yrs	👶 Minimal trauma. NAI if pre-walking. Clues: can crawl but won’t walk.	🔍 Often occult on initial XR. 📸 Periosteal reaction by day 10.	🦵 Long leg cast. 📅 Repeat XR if persistent refusal to WB.	📅 Fracture clinic once confirmed.
Osgood–Schlatter	🎾 Teen overuse, pain/swelling at tibial tubercle.	⚠️ May mimic tuberosity fracture. XR not always required.	💊 Rest, analgesia, reassurance.	🏠 Discharge ± GP physio referral.
Fibula (Head / Shaft)	💥 Direct blow, rarely isolated.	⚡ Peroneal nerve risk → check dorsiflexion. 🦶 Check ankle ligaments (tib-fib, deltoid).	🩹 Analgesia ± BK cast or crutches if stable.	📅 Fracture clinic if isolated. 🚨 Refer if associated ankle injury.

📌 Exam Pearls:
– Always document NV exam.
– Mid-shaft tibia → watch for compartment syndrome.
– Toddler’s # often occult → repeat imaging.
– Osgood–Schlatter self-limiting.
– Fibula # may mean ankle instability.

🦶 Ankle & Foot Injuries

📌 Re-XR displaced # after POP. 💡 NICE: unstable ankle # → fixation within 24–36 hrs. Discuss early with T&O.

INJURY SITE	🛠️ TYPICAL MECHANISM	⚠️ PITFALLS / COMPLICATIONS	🏥 ED / MIU / UCC TREATMENT	📅 FOLLOW-UP
Isolated lateral malleolar # (no talar shift)	↔️ Inversion > eversion.	⚠️ Deltoid rupture = unstable. Always examine medial malleolus.	1️⃣ Avulsion tip → sprain management. 2️⃣ Weber A/B (no shift) → Ortho boot. 3️⃣ Weber B/C + deltoid suspicion → BK backslab.	1️⃣ Discharge. 2️⃣ Fracture clinic. 3️⃣ 🚨 Ortho referral.
Medial malleolar # or talar shift	Indirect forces.	⚠️ Fibular head tenderness may = Maisonneuve #.	🔧 ED reduction ± sedation.	🚨 Immediate ortho referral.
Lateral malleolar # + talar shift	↔️ Inversion/eversion.	⚠️ Indicates deltoid tear. Accurate reduction essential to prevent OA.	🔧 Reduce in ED ± sedation. 🩹 BK slab at 90° flexion.	🚨 Ortho referral post-reduction.
Bi/Tri-malleolar #	💥 Severe inversion/eversion.	⚠️ Manipulation usually inadequate.	🔧 Manipulate for swelling relief. 🩹 BK slab at 90°.	🚨 Ortho referral. Avoid repeated attempts.
Dislocated ankle	⚡ High-energy trauma.	⚠️ NV compromise → “tight white skin”.	🧾 Document NV before/after. 🔧 Manipulate immediately. 🩹 BK POP slab (split).	🚨 Immediate ortho referral.
Talus fracture	⬆️ Forced dorsiflexion (usually neck). Small flake # possible.	⚠️ Risk of AVN. Flake # → conservative management.	🩹 BK POP slab + crutches.	🚨 Ortho referral if intra-articular / concern → CT early.

🩹 Soft Tissue Ankle Injuries

INJURY SITE	🛠️ TYPICAL MECHANISM	⚠️ PITFALLS / COMPLICATIONS	🏥 ED / MIU / UCC TREATMENT	📅 FOLLOW-UP
Lateral ligament sprain	↔️ Severe inversion/adduction.	⚠️ Use Ottawa Ankle Rules. Often maximal tenderness just below fibula tip.	🦶 Severe sprain → Ortho boot × 5d. Otherwise RICE + leaflet.	📅 Physio (ED or GP referral).
Achilles rupture	💥 Sudden posterior pain. ❌ No movement on calf squeeze.	⚠️ May retain plantarflexion → calf squeeze essential.	🩹 BK POP in equinus.	👨‍⚕️ <55/active → discuss percutaneous repair. Otherwise fracture clinic.
Calf strain	Similar to rupture but tendon intact.	✅ Always document Achilles intact.	💊 Rest, analgesia, reassurance.	🏠 Discharge ± ED physio.

📌 Exam Pearls:
– Always re-XR displaced # after POP.
– NV status must be documented.
– Maisonneuve # = medial + fibular head tenderness.
– Achilles rupture → calf squeeze is diagnostic.
– NICE: unstable ankle # → fixation within 24–36h.

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Lower Limb Fractures and Injuries

🦴 Femoral Fractures & Injuries

🦵 Knee Fractures & Injuries

🦴 Tibia & Fibula Fractures

🦶 Ankle & Foot Injuries

🩹 Soft Tissue Ankle Injuries

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