Extremity trauma: field management of sports injuries

Abstract

Traumatic injuries to the extremities are common in athletic competitions. The practitioner providing coverage of sporting events must be prepared to diagnose and provide initial treatment of these injuries. A thorough history and physical examination should result in a provisional diagnosis. Many injuries will require subsequent radiographs or orthopedic consultation. Limb threatening emergencies are rare but must be promptly recognized and referred to a hospital. Early treatment can protect athletes from further injury and may hasten their return to competition. Some athletes with extremity trauma can return to the contest, but this decision must be made on an individual basis.

Fig. 1

A 20-year-old male football player sustained a twisting injury to the left ankle when being tackled. He was unable to bear weight on his left leg. Examination on the field showed severe tenderness over the deltoid ligament, the syndesmosis, and the distal fibular shaft. Crepitus was also present over the fibula. He was removed from play and PRICE therapy was initiated. Radiographs were obtained. An A/P radiograph (a) demonstrates a distal fibular shaft fracture, widening of the syndesmosis, and increased medial joint space. Immediate PRICE therapy minimized the soft tissue trauma and allowed early surgical stabilization of his injuries (b)