Clinical Case Database / Category: Clinical Care
Nikolaos Gougoulias MD, PhD, Anil Khanna, Nicola Maffulli
Foundation Years Journal, volume 3, issue 8, p.36 (123Doc Education, London, October 2010)
A 42-year-old man was presented to the A&E department with a temperature of 39Â°C, feeling unwell. Heart rate was 110bpm, blood pressure 100/60mmHg, respiratory rate 24 breaths/minute, oxygen saturation on room air 90%. He had no chest pain, or abnormal neurological findings. Chest auscultation and ECG were normal. He smoked 20 cigarettes/day, and his past medical history was unremarkable. He sustained an open fracture of his left tibia and fibula 8 months previously. This was managed with an ankle spanning external fixation, and open reduction internal fixation of the fibula. The external fixator was removed 4 weeks before presentation at the A&E, and the patient was mobilising with a removable ankle brace. He had pain in his distal tibia and a pus discharging sinus (Figure 1) had developed in the last few days. Radiographs of his left tibia were requested (Figure 2). What is your assessment? How should this patient be managed?
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Nikolaos Gougoulias MD, PhD
Clinical Fellow Royal Surrey and Frimley Park Hospitals
Registrar in Orthopaedics
University Hospital North Staffordshire
Umile Giuseppe Longo
Registrar in Orthopaedics
Campus Biomedico University
Professor of Sports and Exercise Medicine and Surgery
Consultant Trauma and Orthopaedic Surgeon
Centre for Sports and Exercise Medicine
Queen Mary University of London
Barts and the London School of Medicine
Mile End Hospital
275 Bancroft Road
London E1 4DG
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