Clinical Case Database / Category: Clinical Care


Publication details

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 39°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

CCT Orthopaedics
Clinical Fellow Royal Surrey and Frimley Park Hospitals

Anil Khanna

Anil Khanna
Registrar in Orthopaedics
University Hospital North Staffordshire
Umile Giuseppe Longo
Registrar in Orthopaedics
Campus Biomedico University

Nicola Maffulli

Nicola Maffulli
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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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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